Medication Interaction

[JAH8181]

What is the name of your state (only U.S. law)? Pennsylvania

Please bear with me here. This is a long, rather complicated story. (I already tried to post it once, but while I was typing I automatically logged out of the forum and lots it all. I'm not thrilled about having to retype.)

To start off let me tell you a bit about myself. I have have bipolar disorder. I seem to have been showing symptoms of it since I was a small child, but only diagnosed started treatment as an adult. It was treatment resistant. I spent many years living a rather unfulfilling existence which involved about two trips to the hospital per year until they tried Lamictal. Despite the bad rap it has gotten it was like a miracle drug for me. After that got well enough to have a part time job, and go to college full time studying psychology, and taking honors classes. While I've been on and off a few different things accompanying it Lamictal has been the one constant.

Then about three year ago I started having issues. That's when I went to my last semester of college, by the fall I had no will to register for classes that fall. Also worth noting that same year I was diagnosed with a endometrial cyst which wasn't a big deal. I had it removed by D&C later that year. When I was researching about endometrial cysts (because I'm a nerd). I learned that taking birth control reduces your risk of gynecological cancers. Fun. I had taken birth control before, but it was usually just to stop my period when it had gone on too long. I don't particularly like taking it because it makes me nauseous. After I started them three years ago I would take them more regularly, but would stop them every few months. (Nothing really became of the cyst. FYI)

I never really recovered from my 'down'. I had originally thought it it was just stress from school, but even by the end of the summer I had no will to even apply for student aid let along apply for classes, or go to them. My desired to do just about anything has been gone almost entirely for the last three years. I have been in the constant care of a psychiatrist who will not prescribe my meds unless I come and see him every three months, but because I wasn't recovering I was probably seeing him -at least- 6 times a year. During that time he's put me on, and taken me off all sorts of things, inclucding therapy and hospitalization, and raised my Lamictal dose up to the maximum. Nothing has worked though.

Then, in January of this year, I started to develop some freaky symptoms that were definitely from some sort of endocrine disorder. To make a long story short I was diagnosed with PCOS (which is not a very big deal (knock on wood)). In the end I was referred to an endocrinologist, and she put me on spironolactone which is a hormone blocker. However, she refused to give me the prescription until I had a new prescription for birth control because of the birth defects associated with spironolactone. I go to my OBGYN in the spring, and my check up was overdue because I was running around with the PCOS circus.

Having PCOS made me feel like I had constant PMS from January until April when I was diagnosed so I thought that once I was treated I would feel like a million bucks. Fortunately the spironolactone got rid of, or at least halted the progression of, all of my symptoms. Unfortunately I entered the most oppressive bought of depression I have ever had in my entire life. I have been severely suicidal off and on, and have spent a good deal of time trying to figure out fool proof ways to kill myself. It's a depression with no real 'ups'. I was going to the psychiatrist this whole time. He has been telling me that we were getting close to the end of our options since my bipolar disorder was treatment resistant and my Lamictal is at maximum, and ECT maybe the next step so I have been -terrified-. It is also worth noting here that whenever I tell other things of medical importance he has been totally uninterested. In fact he has told me such.

So anyway I have an appointment with my endocrinologist coming up. I've been researching my condition (because I'm a nerd) to see if there is anything I should ask her about. Also I have been kind of curious about my PCOS since it came long after puberty, and the symptoms came on so quickly. My doctor gave me a really thorough series of tests. However things being what they are and considering I have had such severe depression in the last few months I have been wondering.

I have been looking through disorders with similar symptoms, but there isn't anything I have found that wouldn't have been discovered in one of the tests I was given. I did take note of a mention that anti-convulcants (of which lamictal is one) could cause endocrine disorders. I decided to look up the side effects of lamictal on the official website. The endocrine disorders weren't anything like what is wrong with me, but I kept reading. Then I saw 'drug interactions' and 'birth control'. Apparently the main ingredient in not -only- the birth control I take now, but all the types of birth control I have taken -blocks- lamictal, causing it not to be effective. Yep. The medication that I have been taking during the entire time my mood was so wonky I couldn't function, and most severely during the time when I was most depressed is known to -block- the primary medication I take for my bipolar disorder. My psychiatrist -knew- I was taking it. I know he knew because I have to fill out a a form with all my medications on it every time I go for an appointment the 6+ times I go to see him a year!

Now for the questions:

1) Do I have a case? It should be known that even if I -do- have a case I would not be overly happy about it. The thought of the stress that would cause me after how depressed I have been this year alone scares the crap out of me. The only reason why I even bother asking is because the last three years of my life have been -hell-. I feel like I haven't been much more than a waste of space, and a tedious burden on people. The thought that if three years ago someone could have said, 'Gee, don't start taking that birth control! It will mess with your lamictal!' is somewhat horrifying to me. I have waste these three year. I should be in grad school by now, but instead I don't even have a bachelors degree. All I have is debt from unpaid student loans, and not being able to work. I also really don't like the idea of filing a malpractice suit, but I really think that he should be held accountable for this

2) If I do then how do I proceed? I have an appointment with another psychiatrist. I got it before I knew any of this, because I haven't been getting any better. It takes a while to get an appointment for an evaluation. I am still taking my birth control because I want to finish out the cycle and talk to me endocrinologist before cutting it off. I am about 98% positive that the birth control has been responsible for my inability to recover however. I'm fairly sure that there is some sort of lab work I could get done to test and see if the lamictal is being blocked or not, but for that test to be effective I'll need to keep taking the bc until I get the test done. I have also been considering calling the hospital the practice that is associated with to complain, or writing a letter. I don't know if I should do that before or after I take other steps.

I really do apologize again for how disjointed this is. I know it's a lot of information, and there are probably things that I need to clarify, add, and elaborate on.

 

[OHRoadwarrior]

If you feel the need to consult a med mal attorney, by all means do so. That said, if you review the potential side effects of many medications you will find the side effects you can experience, may in fact be the very reason you are taking them. It appears you are not very active in your own care. That appears to be the biggest problem you have. You should have noticed this conflict and discussed it immediately upon being prescribed a potentially contra intuitive medication.

 

[ecmst12]

You need to discuss this with your psychiatrist. You need to be on BC because you are taking Spiro - it will also help control your PCOS symptoms. Perhaps there is another drug you can try to treat your moods.

 

[JAH8181]

@OHRoadwarrior-> Please read my post before you comment. You post suggests that you haven't, and you also haven't answered my two questions.

However let me address your concerns.

>>If you feel the need to consult a med mal attorney, by all means do so.

I know I can if I want to, however anyone could have told me that. I'm here for legal advice though, more specifically to figure out if I should.

>>That said, if you review the potential side effects of many medications you will find the side effects you can experience, may in fact be the very reason you are taking them.

By the nature of this statement you don't seem to have read what I wrote because that's not particularly relevant. The side effect that I am having is that my birth control is preventing Lamictal from working. I seriously doubt that a doctor would prescribe me a drug with the intention of inhibiting another drug. That sounds a little stupid, don't you think?

>>It appears you are not very active in your own care. That appears to be the biggest problem you have.

If you did read my post I think you would realize by the nature of my post that I have been an advocate for my own care. In fact the only way I discovered the interaction was through self-advocacy. I also, as I said, was a psychology student and taking honors courses. I have during my education taken courses which have discussed abnormal psychology. As a result I know not only the side effects of my own medication, but for medications for disorders I don't even have, and are rarely prescribed anymore. Now considering that I have been having a hard time even getting out of -bed- as of late, as is the nature of my disease, and since I can't afford to subscribe to medical journals I haven't really been able to keep up with all the new developments regarding side effects of my medications.

That said...

There is no interaction with Lamictal and/or anti-convulsants/mood stabilizers on the sheet that comes in the packet with the birth control (I don't know if you are familiar with birth control, but there is a fairly large sheet of effects, side effects, interactions, and instructions for use that comes with it.) I read it twice today to make sure. I also don't recall ever seeing any such warning with the information that came with the Lamictal on the sheet that the pharmacy gives me (I do recheck it maybe twice a year). It will be easy to check and make sure I am correct. I also do not recall seeing one on the sheet that I was given when I was first prescribed Lamictal in the hospital. In fact the only warning in regards to birth control I ever recalling seeing in reference to Lamictal is a warning that anyone who is on it should definitely have a reliable form of birth control because of the chance of birth defects. I don't recall any particular type being specified. When I first went on Lamictal it was a relatively new drug, and had only just been approved for use in treating Bipolar Disorder. I have no doubt that there have been many new side effects that have been discovered since. One of them, iris discoloration, is a 'new' side effect that that I only ever saw documented some time after I started taking it. Hair loss is another one that was not 'officially' logged with the side effects until more recently.

>>You should have noticed this conflict and discussed it immediately upon being prescribed a potentially contra intuitive medication.

I don't mean to be rude because I don't know your experiences, but after reading this I feel like I need to explain something to you because you don't understand. Bipolar disorder is a mental disorder. Simply put bipolar disorder causes your brain to malfunction. Now, for the last three years my brain has been malfunctioning so badly that I have not been able to hold a job, or go to college which is something that gives me more pleasure than anything in the world. When I am depressed my brain is malfunction I hate myself, and the first thing that crosses my mind is not 'I'm depressed because my medication is malfunctioning.' It's 'I'm depressed because I am weak.' That's just the tip of the iceberg. There are many people who are bipolar or have other mental disorders who do not know that they are sick. If fact a lot of people do not get treatment because they think that they are normal, or they feel that they can not be helped. That said I have very little insight into why I am depressed while I am depressed, and that is hardly unusual for a person with bipolar disorder.

 

[JAH8181]

@ecmst

>>You need to discuss this with your psychiatrist.

I doubt it will be productive, but it is worth a try. This might just be my bipolar disorder talking, but I expect him to not know anything about this interaction, or to say that I'm wrong without investigating. I think I will take your advice.

However I have found that there are two sorts of psychiatrists. The first type will answer questions in a detail, and even look things up for you. You can tell that they love the subject of psychiatry and psychology, and love sharing talking about it. The others seem rather annoyed if you ask them questions, and never seem to believe you. A good example is another psychologist I had a few years back. I mentioned to him once that I was under the impression that the medication that her prescribed to me for sleep, seroquel, was making me binge eat (and therefore gain weight). I asked him if that was possible because it was effecting my serotonin, or dopamine. 'No, he said, it doesn't work quite like that.' A few years later I saw a pulminologist about sleep apenea. I didn't have it, but he suggested I lose weight, but said it wouldn't be likely so long as I was on seroquel. I would just keep gaining. Turns out it does actually make you binge eat. Because of that you can gain weight the entire time you are on it (unlike most psychotropics). They also will now give you frequent blood tests to make sure it isn't making you diabetic.

This doctor is very similar. He isn't a listener. I doubt I'll get a much better reaction from him about this issue.

>>You need to be on BC because you are taking Spiro - it will also help control your PCOS symptoms.

Yea, I know, and that's part of the reason why I am waiting to talk to my endocrinologist at least to see if I should go off it. There are also progesterone only birth control pills (which aren't as effective), and depo provera which is also progesterone only (but they suggest that you only use it for two years because it cause you to lose bone density quickly) They do not seem to have the same effect on lamictal though.

>>Perhaps there is another drug you can try to treat your moods.

Not a possibility. For one thing my bipolar disorder is treatment resistant. Lamictal is used for bipolar disorder and epilepsy. It is very strong, and very effective. I am certain that it is the only thing that will help me. Doctors don't like to use it because it's most well known side effect is that it causes 1 in 1000 people's skin to melt off (I'm not. Your skin melts off, and you get burns on your internal organs. They need to treaty you in the burn ward.) Fortunately once you've been on it for a few weeks the danger of that is over.

All bipolar disorder needs to be treated with a mood stabilizer. Even if I -could- use another mood stabilizer I still would not be able to use it with the same sort of birth control pills. All regular birth control pills, to my knowledge, contain ethinyl estradiol. Ethinyl estradiol apparently reacts with all mood stabilizers (which, incidentally, all are also anti-convulsants). Basically there is nothing else, and unless they make a major pharmacological break through there will never be anything else.

Thank you very much for you time and though. You have given me some things to think about, but you can see why this is frustrating for me.

 

[cbg]

Before you decide that I, too, don't know what I'm talking about because I don't answer in the way you want, be aware that one of my closest friends has also been diagnosed with bi-polar disorder and I have gone through many stages of it with her. In addition, at least three close family members suffer from various forms of anxiety or depression for which they are taking medication, and another of my closest friends works in the pharmacology field.

1.) No, you do not have a "case" - not for med-mal, or anything else. It takes time, not just for bi-polar but for any other condition needing multiple medications long term, to find the right "****tail" for the individual. Everyone reacts differently to medications, and your personal reaction to one medication, or combination thereof, is not going to be the same as someone else's reaction to the same medication or combination, and the only way to find out how you react is to try it. If one combination doesn't work, the only way your doctor is going to know this is if you tell him.

2.) N/A

 

[JAH8181]

@cbg

>>No, you do not have a "case" - not for med-mal, or anything else. It takes time, not just for bi-polar but for any other condition needing multiple medications long term, to find the right "****tail" for the >>individual. Everyone reacts differently to medications, and your personal reaction to one medication, or combination thereof, is not going to be the same as someone else's reaction to the same medication or >>combination, and the only way to find out how you react is to try it. If one combination doesn't work, the only way your doctor is going to know this is if you tell him.

In clarification: the issue is not so much that I couldn't be 'fixed'. I the issue is that I was doing was doing well, and leading a productive life, then after being given something (that he should have been aware had the capacity to make me worse) I got worse. Instead of suggesting that the cause of the problem might be this other medication he said nothing, and let me go for years.

 

[commentator]

You need to see a med-mal attorney, because when we wade through all those disjointed and overly detailed posts of yours and come to the conclusion that no, you do not have a case, and tell you so, you keep rejecting it. You should have to pay someone to listen to much of this. And they can give you your own preferred conclusion, as long as you are paying them, and you can file a lawsuit, keyword as long as you are paying them.

Everyone in the world wishes their doctor could perfectly prescribe for them and understand them. Everyone would like to sue someone when they're not well, not reacting well to their meds and not able to fingure out exactly what is wrong or how to get better. Your current situation is not a result of malpractice on the part of your doctor.

 

[cbg]

You completely misinterpreted everything I said.

Please, by all means, pay for a med-mal attorney to tell you what you want to hear.

 

[OHRoadwarrior]

As it appears you do not want to take any personal interest in your failure to monitor your medications, your only recourse is to consult a med mal attorney. We are not here to debate someone in denial.

 

[ecmst12]

There may, in fact, be another medicine that will help you. I don't know your whole medication history (and please, don't tell me). Only your DOCTOR can tell you the best choice.

 

[rubuin]

you need to ask your doctor,i have the same question ,but i am well now,maybe can not help you sorry