Sleeping Pills

This post isn’t what you think it is.

I did try to take pills, once, but this is about a time when pills were forced on me.

I was generally very compliant in hospital, but one thing you learn quickly as a patient is to always check your medication. Your nurse will hand it to you in a little paper cup (like the kind you use to get your ration of ketchup at fast food places. I think ketchup costs them a lot more than the kind I buy. At least they’ve stopped handing it out in the tiny packages that hold a quarter teaspoon).

Anyhow, you get this little paper cup and the first thing you do is count the pills and look at the colours and shapes of them. You learn, for example, that a milligram of Clonazepam is tiny and reddish orange, while the half milligram is large, chalky and orange with a breaking line. Five milligrams of Loxapine is a lime green tablet with a breaking line. Lithium comes in a caplet – the ones with red are 100 milligrams, the half pink, half white ones are 300mg. And so on. You toss them back, and then the nurse makes you open your mouth to see if you swallowed everything.

One evening I spotted a tiny green tablet, only about two millimetres in diameter, hiding at the bottom of my cup. I hadn’t seen one of those before.

I stopped.

“What’s that? I’ve never taken this one before.”

The nurse picked up my chart (charts are gigantic binders, full of all sorts of notes, doctor’s orders, test results, etc. They don’t hang them on the end of your bed).

“It’s a sleeping pill,” she replied after a moment. “Your doctor ordered it this morning.”

“He never told me about it. He didn’t even ask how I was sleeping. I’m sleeping fine – you know that I am. I don’t want to take it.”

She looked concerned.

“Well, for some reason he decided you need it. Can you please just take it tonight?”

I held my ground. I never want to take medication that I don’t need.

“I’m sorry, Jodi, but I don’t need it and I won’t take a medication unless my doctor has talked to me about it.”

She frowned. “So, you’re refusing a medication the doctor ordered?”

“Yep,” I replied, folding my arms.

She was good. Instead of making a fuss, she made me do some paperwork.

I had to sign forms waiving the hospital and nursing staff of liability, and indicating that I was wilfully ignoring a doctor’s orders.

The next morning I saw my psychiatrist. “Why did you order sleeping medication for me?” I queried. I was a little upset.

“I just assumed you needed help sleeping, after all of the stress you’ve been through, especially going through seclusion.”

“Thanks anyways, but please don’t make assumptions. I’m sleeping fine.”

(I thought about that old aphorism – “You know what happens when you assume? You’re an idiot.” That’s my version, anyways).

During my stay, I discovered three more medication errors.

If you are ever hospitalized for anything (and I hope you aren’t), always check your own medications.

It’s better to know exactly what’s in that little paper cup than to not.

That’s why I’m so wary of fast-food ketchup.

PRN

I was visiting the Mood Disorders Association clinic. One of the psychiatrists asked me what I was using for a PRN. A PRN is a medication that you take in an emergency. The initials are from the Latin, “pro re nata.”

“Ativan, one or two milligrams,” I replied.

“Where is it?”

“At home.”

He smiled. “How is it going to help you from home? Carry a couple of tablets with you in your wallet, okay?”

Running was a major part of keeping me stable and functioning while my wife was in hospital. Shortly after my visit to the clinic, I saw my wife, and she wasn’t doing well. The kids were at school. I decided to go for a run.

Usually, a jog would cheer me up, but not this day. As I hit the last six kilometers of my route, I started to feel like everything around me was unreal and that my life was coming undone. I came to a large bridge.

Midway across it I felt a strong urge to jump off – like when you stand on the edge of a pool and are teetering because you know the water is cold, but you want to swim.

I reached toward the railing.

It took every ounce of my will and training to stop.

I took all of the Ativan I had in my wallet and put it under my tongue. I thought about my kids. I felt the cement under me. I thought about everything I could to ground myself and return to reality.

After about ten minutes I could feel the drug start to work. The impulse disappeared, my mind relaxed.

I was shaken, but finished my run home. Near the end, I saw a good friend out walking her dog. She waved and I stopped. She asked how I was doing and I burst into tears. I couldn’t believe what had almost happened.

I saw my doctor right away. My medications were adjusted to help make sure that I wouldn’t get that depressed again.

The PRN did what it is supposed to do. It is the last line of defence with mental illness.

It terrified me to reach the point where I needed it. Hopefully, with the treatment I’m receiving now, it will never happen again.

Mythium

I am always hesitant to let people know what medication I am currently taking, especially in my neighbourhood where there are lots of alternative medical practitioners that many of my friends use. In my experience, these practioners and their patients are often at odds with Western medicine - especially the overuse of drugs and big pharmaceutical companies. I often agree with them.

Perhaps the drug that elicits the most dramatic response is lithium. There is a kind of irony to this, because out of almost every medication available today lithium is the most "natural." It is a metal that comes straight out of the ground.

What is lithium used for? Well, it's in the batteries that power your phone and laptop; it is a component of nuclear warheads; it's used in high quality pottery glazes; it's used in rocket fuel; it was an ingredient in the 1930's in the original 7-Up soft drink; and it has been used as a mood stabilizer for over 100 years, if not thousands (there are stories of ancient Greeks being prescribed water from alkali springs to treat mood swings. The springs are full of lithium).

What are some of the misconceptions? It is widely believed that lithium is dangerous; that it impairs kidney and thyroid functions; it becomes toxic; and that it makes you flat - you lose your creativity.

I was worried about all of these things when it was first suggested that I take lithium. The myths persist even among some doctors. Just before I found a family doctor (who is fabulous, by the way!) the doctor at the clinic I attended refused to prescribe it, in spite of the written directions from a psychiatrist at the Mood Disorders Association clinic. "Too dangerous," he clucked. "Easy for it to become toxic."

Well, when I got my family doctor and returned to the psychiatric clinic, it became clear that lithium was the drug that would best help me. The other mood stabilizer I had been trying just wasn't cutting it, and I was going downhill fast.

I've also been prescribed an atypical antipsychotic that has sped up the lithium (nomally you have to wait a month or two for it to become effective). I am still on the first mood stabilizer, and an anti-anxiety medication to help curb my stress. It's all working together nicely.

With lithium I can still run marathons. I just have to stay hydrated. It acts like salt in your body. At home I can tell when I need to drink more water, because I will get small tremors in my hands.

I go for blood tests every three months to check my lithium levels, to ensure that I am getting the correct amount. Unlike other psychiatric meds, it has a brief half-life. Stop taking it, and three days later your blood levels are almost zero.

Lithium gets a bum rap. If you are ever in a situation where you need a mood stabilizer, it is the gold standard. Don't let myths get in the way of your treatment.