labile

That's really the only way to describe me lately. I've been up and down and up and down, screaming at customer service reps on the phone, getting tearful and anxious around the house, fits of rage towards the dogs or what have you... it hasn't been good. Yes, this lability was worsened after cutting down the Geodon from 160 to 80mg. I'm also less sedated and not having any akathisia at this lower dose, which is good. I saw the doctor on Friday, and he prescribed an additional 20mg of Geodon for me. I'm not sure if I want to try to take it in the mornings with breakfast, or take the entire 100mg dose at night. Something tells me I may have more motivation if I take it in the morning. Anyway, the pharmacy was out of 20mg, so I won't be getting that until this evening.

On Friday, when I saw the doctor, I also explained that I was trying to be more active, but struggling with joint pain. I can't take ibuprofen, only Tylenol and aspirin, and neither of them touch the pain, especially the pain in my back. So my pdoc wrote me a script for sulindac, the only non-aspirin NSAID that doesn't interact with lithium. I'm getting that tonight as well. I'm excited, because maybe I'll be able to walk more without bitching. Today, I'm trying to work up the motivation to do an ab routine on the floor in the living room or office...just to get sweaty and feel like I've done something. From my high of 288, I'm now at 270 even. So, I somehow managed to lose 18 pounds due to Geodon's appetite suppression. Good news.

Geodon is doing a bang-up job of controlling tactile hallucinations and psychosis. It really is. I don't get ants anymore unless something triggers them, a big one being sweat dripping down the back of my neck, or seeing any sort of insect. Geodon has also been helping with motivation...I'm probably the most motivated now that I've ever been without something like a stimulant or Wellbutrin. I feel capable of more things. I just wish my mood symptoms were more controlled, and that I didn't have so much room to swing from high to low. So I'm thinking of doing one of two things.

Option A. Asking for an increase in lithium. My last lithium blood level, a month ago, was .8. Pdoc thinks that that's perfect, and wants to hold the dose at the same level. I could probably increase to 1200mg/day and get my blood level around 1.0, and that might help shave the top and the bottom off my mood ranges, which mostly consists of highs of anger/rage and lows of depression. I don't think that the pdoc is going to go for this approach.

Option B. Asking for an additional mood stabilizer. Several weeks ago I did all the research to figure out what mood stabilizers I can take without them fucking with my hormones. There aren't many, and of the short list (Keppra, Neurontin, Zonegran), Zonegran is the one I'd look to try, because Keppra causes depression as a side effect (don't need that, thanks), and Neurontin, while good for anxiety, doesn't do a whole lot for mood stabilization. Zonegran has a very mild side effect profile, could help me lose weight, and act as a mood stabilizer. This may be an easier sell, because pdoc is ALL ABOUT me losing weight. I said exercise and his eyes lit up. He's always discussing weight gain/loss side effects. It's almost annoying, because I KNOW I'm fat, doc...can we focus on getting my head right? But this would do both. So. This being the preferred option, and my next appointment being in two weeks, here's the plan:

1) Keep playing with Geodon. At 100mg, then maybe trying 120mg daily. Try to get to a dose that gives me minimal side effects and maximum effect.
2) Be clear about my residual symptoms of lability/mood swings, anger, depression.
3) After a couple of dose tweaks on Geodon (so a month from now, not my immediate next appointment), suggest the Zonegran and see what his response is.

I don't know. It seems like it could work. It seems worth trying. So we'll see if he goes for it.

Now, to deal with these pesky beasts, begging to play outside, and try to get in my little smidgen of exercise for the day.