It takes a lot of courage to come off medications. This time 8 weeks ago I was on 100mg zoloft, 1750mg lithium and 15mg olanzapine to control my bipolar I disorder. This is a lot of medication for a stable person to be on, but 8 weeks ago I was not stable and instead trying to recover from a hypomanic episode. For those who are not sure, hypomanic episodes are characterised by an intense period of energy and creativity, with some lead ins to mania such as paranoia. The lithium is meant to keep me stable but if anything disrupts the level of lithium in my blood, for example increased blood volume cause by pregnancy, then I am more susceptible to an episode. My lithium levels usually sit at a 0.7, but through the pregnancy it has been only at 0.4 meaning that the medication is not working. In this case I need to begin an antipsychotic, usually risperidone, but in this case it had to be olanzapine as it is the safest in pregnancy. The dose was started off a small and then increased rapidly to try and control the increasing manic symptoms. We gauged my levels of olanzapine based on sleep and ability to concentrate at work.
The last 4 weeks I have been reducing my medication, mainly because the lithium levels are super low at 0.3, and the zoloft (which is an antidepressant) can exacerbate the mania as it is releasing counter-productive chemicals – serotonin- into my brain thereby making the episode more acute. I reduced the zoloft rapidly and am today beginning my second week on 0mg zoloft. Simultaneously I have reduced my lithium in the past 2 weeks down to 1250mg in the hope that I can come off it completely in the next four weeks. I am controlling my mood with olanzapine alone, and we are confident this is the right course.
Of course I should say at this point that you should only reduce or increase medications after talking to your doctor. We decided to decrease based on discussions with my GP as it has been over two months since my last psychiatrist appointment. I have an appointment with the psychiatrist tomorrow (on my birthday, yay) and hope that they are supportive of our decision. As we discussed with the perinatal counsellor last week, we don’t plan on increasing medications past the recommended dose. Increasing past thr recommended dose for lithium (2000mg) is what the psychiatrist was advising my GP only 4 weeks ago. The potential risks to bub regarding pre term labour is not something we want, and we also do not want a ‘controlled birth’ or induction. We want everyone to be happy and healthy, and in our eyes I am stable now and the lithium is doing little to control. Also I would have to increase dramatically to get anywhere near the 0.7 range. The counsellor also helpfully advised that they can only intervene if I am causing risk to myself or others, or if my mood becomes unstable and I am not making the right decisions for the wellbeing of all.
I think we are making the right choice in the medication, given that I am no longer hypomanic. I am a little on edge, quick to temper and irritable but these are all side effects of reducing the zoloft and to a lesser extent, the other medications. I am nervous about the appointment tomorrow as I am not going with Mr A so have no ‘back-up’ although hopefully our session with the counsellor last week means that she will advocate for me in the meeting, if need be.