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I Missed My Meds… July 22, 2011

Posted by Crazy Mermaid in Uncategorized.

I missed my dose of medication Wednesday evening. It happened innocently enough. On a local vacation, we spent Tuesday evening at my sister-in-law’s cabin. We moved to my mother-in-law’s house Wednesday afternoon, which is about an hour away from my sister-in-law’s cabin.  As we sat around the card table playing rummy-cube that evening, I rose to get my purse to take my medication just like I do every evening at 9:00.  Searching through every pocket of my purse, I came to the realization that the pills were still at the cabin.  What should I do about that?  Should I say something?

I returned to the table, deciding to tell my husband where the pills were, and leaving it up to him to decide whether to drive back to the cabin to retrieve them.  My mother-in-law, bless her heart, didn’t understand the situation completely.  Thinking it was blood pressure pills or cholesterol pills, she offered to loan me any of her store of pills.  I explained that these were my “crazy” pills, and that she didn’t have what I needed. I was pleased and surprised when she said that I wasn’t really crazy, indicating that I shouldn’t call the pills by that name.

In the end, my husband decided not to go get the pills, with the understanding that we would retrieve the pills the next morning.

On a typical night, I take my pills the same time, which is 9:00. I never know exactly when they’ll take effect, which is to say I don’t know exactly when they’re going to knock me out on any particular day.  Some times it’s within an hour of taking them,  while at other times it’s three hours or more before the pills knock me out.  So I decided to go to bed at 11:00, which was about my usual bedtime.  I didn’t know what to expect when I laid my head down on the pillow.

I lay there, listening to my husband drift off to sleep before I did, which hadn’t happened since I began taking the medication three years ago.  As it happened, my in-laws live near a naval base, and the pilots decided, for whatever reason, to do low fly-bys that evening.  We noticed the sound of the planes as we played cards at around 8:00 p.m.. I assumed that the fly-bys would cease around midnight. I was wrong.

Midnight came and went, and the planes droned on.  As I lay in bed listening to them, my full bladder got the best of me, and I rose to take care of it, glancing at my watch as I walked down the night-light lit hallway. 1:00 a.m. Great! Even if I fell asleep right then, I would only get 7 hours of sleep before I had to get up. And I needed at least 8 to be functional.  I lay in bed worried about my lack of sleep as  3:00 came and went. At around 4:30, the sun streamed through the window between the window blinds, and I was still awake.  At 5:00 a.m., my husbands’ eyes opened.

“I haven’t slept all night, “ I said. “And I mean ALL NIGHT. This isn’t good.”

“Oh,” he said.And he fell back asleep.

Finally, shortly after 5:00 a.m., I, too, fell asleep. For an hour. Then another hour. Then another hour.  Three hours total.

One of the things my psychiatrist has succeeded in drilling into me was that too little sleep would bring on a manic episode.  Too little sleep for me was anything less than about 8 ½ hours. So as I lay there wide awake hour after hour, a sense of panic took hold.  I worried that every hour of wakefulness combined with my lack of medication brought me closer to a psychotic episode.

The crazy thing is that when I woke at 8:00 a.m. after only three hours, I felt entirely awake and clear-headed, something that had eluded me for the past 3 years.  Every morning for three long years it had been a fight to get my head clear and  fight through the incredible lethargy that enclosed my mind for several hours after waking.  I hadn’t realized until the moment I awoke clear-headed how much I missed waking up refreshed.  Before my psychotic episode, I woke fully functional and awake every morning at around 5. I had forgotten just how wonderful that feeling was.

I  waited all day to see if something bad would happen.  Would I get psychotic right away?  Or would it take more than one day of no meds to bring it on?  Nothing happened all day except for the fact that I ended up nodding off at around 1:30 for about 1 ½ hours of sleep.  So overall I survived on 5 ½ hours of sleep and nothing bad happened.

Does the fact that nothing bad happened mean that I really don’t need my medication?  What would happen if I missed more than one day?  How long would it take for my symptoms to reappear?  Or is the whole diagnosis a misunderstanding? Maybe I really don’t have bipolar disorder.  Is not having any symptoms after missing my dose indicative of a misdiagnosis?  Or did I simply heal enough that I don’t need my medication any more?  All of these thoughts and more went thought my head.

As night time approached, I truly didn’t know which path I would choose. Would I take my medication and return to the world of lethargy and grogginess, or would I opt for a more wakeful life and stop taking my medication once and for all?

As I thought about the situation, I recalled a conversation I recently had with my psychiatrist.  At my last visit with him, I had expressed the possibility that I was now cured and no longer needed my medication. Or,  I suggested, maybe the whole bipolar diagnosis had been s a giant mistake, and maybe I didn’t really have bipolar disorder. As I sat there sending up trial balloons, he told me something that I didn’t want to hear. He said that my brain chemistry had been irrevocably changed by my psychotic episode, and that I wasn’t going to “outgrow” my diagnosis.  Not taking my medication, he said, would bring my symptoms back.

In the end, I swallowed my pills like a good girl.

(Note: One of my readers supplied me with this excellent link about the “kindling effect”: http://bipolar.about.com/cs/brainchemistry/a/0009_kindling1.htm_ Thanks, CJM!)




1. Catherine - July 23, 2011

A very interesting post. Journalists continue to debate whether the meds themselves changes one’s brain chemistry in a way that makes one ‘dependent’ for life, or whether a psychotic episode changes one’s brain irrevocably. You might talk with your doc about brief med holidays–or talk to a couple of docs. Because one thing we know for sure is that people who are consistently on a particular medication get med fatigue, where the brain wants to outsmart the meds, and they become less effective. Your doctor I’m sure wants to keep you safe, but I’d ask for the studies that support his recommendation. My feeling is it’s not particularly scientific.

2. lunasunshine - July 26, 2011

I’ve had days where I’ve missed my meds, sometimes because I just plain forgot and others because I didn’t have the money to get my scripts filled. Here’s the scoop. Sometimes it’s OK, and sometimes it’s bad. I have a theory regarding that.

You mentioned that on any given night, you are unsure as to when your medication will take effect. I have the same dilemma, which has forced me to move my dose up to 8PM just to make sure that I am somewhere near asleep by 12AM. That gives me 4 hours to metabolize the medication. Sometimes, I’m falling asleep on the sofa at 9PM and sometimes I’m still raring to go at 1AM. I realized what causes this. The way the medication metabolizes works on several factors – 1.) What time did I eat dinner? My medication is less effective if I’ve eaten right before taking it. 2.) What was my activity level that day? If it was low, then my body seems to have a more difficult time processing it and 3.) What is my current episode? If it is anywhere other than stable, then the insomnia starts.

This brings me to my point of whether medication works or not. It really depends on how your body has metabolized the last dose. You may still have some in your body to work off of, which is why it wasn’t completely catastrophic when you missed a dose. In addition, any side effects that you’ve been having would be very diminished at that time. So you may want to talk to your doctor about lowering your doses temporarily to see if you have a better effect.

I don’t buy the whole “medicine changes our chemistry” debate. As women, we face the fact that our body chemistry is changing throughout our lifetimes, and even through our days. Just our menstrual cycles alone make each day different with the amount of hormones in our bodies. So therefore, any chemicals we put into our bodies will have different reactions each time. I think doctors, especially male ones, forget this fact.

3. Crazy Mermaid - July 26, 2011

I checked with my psychiatrist today, and he said that it’s really important for me to stay on my medication regimen. There’s something called the “kindling effect”, which means that if you start messing with the dosage of the meds, the meds stop working. So it’s not a good idea to go without my meds every few days or weeks. He said he wishes that I hadn’t experienced that day without my pills, because it will make me more likely to stop taking them. He reminded me that over 75 % of all people on these meds stop taking them at some point, and that would be a disaster in my case.

CJM - July 27, 2011

Kindling is really interesting–thanks–I’ll read more on it. The following article also talks about the work that has been done with epilepsy models to help understand bipolar illness.


Crazy Mermaid - August 2, 2011

Thanks for that article on “kindling”. It was fascinating. I hope that more people look at it.

4. CJM - July 27, 2011

I also want to recommend a great book of very current research articles: Brain Protection in Schizophrenia, Mood and Cognitive Disorders, edited by Michael S. Ritsner. It’s a difficult, technical book, but I think anyone with interest could get a lot out of it, even if you only grasp 10% of what’s there. Ask your library to order it if you’re interested (it’s $250+ to buy). We think of protecting out heart, even our muscles, but few people think much of protecting their brains.

5. troy - July 27, 2011

The ‘med holiday’ was my second thought ….my first was the idea that taking meds regularly would also change brain chemistry. Irrevocably too perhaps.

Doctors know best I suppose. But then again lol, do they? The best case scenario would be to go off your meds under strict and constant supervision. Of course you’d be something of a guinea pig in your own experiment though, and that might be far worse than simply staying the course.

6. CJM - July 27, 2011

I thought I already posted this link on kindling–interesting concept:

I’ve heard of this with regard to epilepsy, and also seizures related to cardiac events, but the concept makes sense for any aberrant brain function, I suppose–the brain finds a new path or a new chemical state, and reverts to that, maybe assuming that the adrenaline that was being pumped at that time signaled a reason to learn this new, ‘useful’ thing. Fascinating stuff, and surely only partially understood. Keep up the blog–I enjoy your story.

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