sexual dysfunction
My Email:
Fri, May 15, 2020, 12:57 PM
Hello Dr. Coplan,
The sexual dysfunction has become worse. I'm sure it's the meds, probably prolactin. I'm hoping to decrease meds, rather than increase Caberoline since I'm already on 2 mg weekly. I wish I mentioned it at the appointment (two days ago) because I really don't want to ignore it until next appointment.
Thanks
Dr. Coplan Reply:
Fri, May 15, 2020, 3:26 PM
to me
How much invega are you on, Andrew?
My Email:
Fri, May 15, 2020, 3:54 PM
I'm on Invega 9 mg.
Here's my list of medications that I'm on at the moment:
Invega 9 mg at night once a day
Lamotrigine (Lamictal) 125 mg once a day
Latuda 40 mg at night once a day
Lithium 600 mg (300 am, 300 pm)
(Xanax .25 (as needed))
Cabergoline 2 mg weekly
Levothyroxine (thyroid) 75 mg (for thyroid adverse effects)
Ondansetron 4mg at night (so not to throw up, Latuda/Invega adverse effect)
Rivastigmine 3 mg twice a day (so 3 in morning, 3 at night) (for Memory/adverse effect), so 6 mg
My Email:
Fri, May 15, 2020, 4:12 PM
Hello, Dr. Coplan.
I just had a chat with Dr. Garrett,
I'd love to address the medication issue sooner rather than later. Yes, they're so many adverse effects (sexual dysfunction). But we decided reducing the Invega and potentially going into full-blown psychosis during the Coronavirus pandemic might not be wise. Meaning, I don't want to wind up in the hospital, then get Corona.
When society becomes more stable because I've made a lot of progress with Dr. Garrett, I hope we can tweak something and see how I do on fewer meds. I suspect I'll be fine.
Dr. Coplan Reply:
Fri, May 15, 2020, 4:43 PM
OK Andrew we can certainly consider testing out how well you are on lower meds. However, my observation is that we are already having several "psychotic" episodes that through the help of cognitve reframing and meds you are thankfully able to navigate your way out of. Some of the manic features of thesse episodes can be induced by rapid caffeine intake in large amounts, which we agreed was not an ideal strategy. The problem is that the delusions invariably entail nefarious action on behalf of one or both parents. When I first met you, your mother recounted how you had spent several inpatient admissions delusionally convinced you had been abused by your parent(s) as a child and would yell out this revelation to all comers. So it is a precarious line we are dealing with and the "original delusion" is still regularly retreived. I need to discuss this with Dr Garrett but I dont share the sense that you are safely situated and well removed from the delusions. An important component of these delusions is their inevitable necessity to be widely "announced" in an attempt to correct the "wrongs" of the past. This makes the delusions non-benign as even if you come out of them you have communicated them with full conviction to any available audience. With consequence. That being said it is to your credit that you have continued being perfectly compliant with this unweildly combination of meds and their upsetting side effects.
As I say I need to discuss the state of the delusions with Dr Garrett before endorsing that lowering the meds is a low risk exercise clinically.
SIncerely
Dr Coplan
My Email:
Fri, May 15, 2020, 5:06 PM
Yes, I've been perfectly compliant with my meds since 2011/2012. Actually, I'm afraid being on a mega regimen for this long can be carcinogenic. But I'm also aware it's helping. Everyone says the meds are well-researched and they're many people at the Fountain House who've been on meds their whole life, and they're in their 60's, are continuing to have a lengthy life.
While the Coronavirus is happening, it wouldn't be wise to risk a hospitalization by lowering my meds. Though, I suspect I'd be fine. I'd love to test it out as soon as we can.
With Dr. Garrett I've made a huge recovery and am able to recognize and come out of delusions now. I don't get completely lost in psychosis anymore. I'm not the same as I was back then. Because in 2011 I couldn't even verbalize it was a delusion. Now I'm able to explain the way my mind works. That's HUGE!
The coffee intake has reduced since the extreme days, I only have 3 cups a day. In fact, I tried to stop completely but got massive headaches and fatigue. So I still drink some.
If we do come down on meds it has to be done right. But first, let's get through this Coronavirus nightmare.
Dr. Garrett Reply:
May 15, 2020, 5:31 PM
Andrew
I agree with the points Dr Coplan makes. You are able to use your cognitive skills to pull yourself out of a nosedive into delusonal daydreaming much more effectively than used to be the case, but the idea that your parents are sadistic abusers is still very close to the surface still. Your were caught up in these thoughts last week.
Here is a metaphor. You know when you go to the beach and try to stand up in the receding tide, but sometimes the tide knocks you over. If you were to be on less medication and your biology started to catch you in a rip tide that knocked you down, it would be quite damaging to your recovery. You have made definite progress in psychotherapy. You are getting stronger psychologically. But I would not recommend, especially now with hospitals preoccupied with COVID, that a risk be taken at this time.
It is hard to pick one indicator of how strong you are psychologically, but the daydream that your mother takes pleasure in sexually abusing you is an important marker. Since I have been working with you, though I don't keep a specific record of this, I think the longest you have gone without that delusion resurfacing is 10 days to 2 weeks. The delusion fades more quickly than in the past, but it isn't gone. It is still too close to the surface to take a risk now, frustrating as your situation is. In a spirit of dark humor, which I know you enjoy, which would you prefer - sexual frustration or re-hospitalization? I hope the former rather than the later.
Dr G
My Email:
Fri, May 15, 2020, 8:41 PM
I guess you're right. I was just getting the thoughts that my parents are the bane of my existence shortly before writing this e-mail. That they intentionally and nefariously sabotaged my life and I should have been rich and famous years ago. If I start taking less medication, perhaps I'll be overwhelmed by the ocean tide and get lost in full-blown psychosis. I think socialization and a REAL life is the key to recovery. Unfortunately, it's hard during the Coronavirus. Hopefully, we can attempt fewer meds someday, though.
The sexual dysfunction is VERY FRUSTRATING, but it's better than a hospitalization.
Dr. Coplan Reply:
Sat, May 16, 2020, 1:47 PM
From what we know, by treating the disorders we reduce body-wide inflammation. And inflammation can switch off tumor surveillance by T-cells.
My Email:
Sat, May 16, 2020, 2:20 PM
It's good that the medications don't cause cancer. As you said, they actually prevent cancer. I want to live a long and healthy life.
At the moment, I'm getting the thoughts that Syd Barrett is my TRUE biological father and my parents did nefarious things as a result. Conspire, restrict, and sabotage my life. Assuming this is a delusion and my chains are internal, if we lower my meds, I wouldn't even be able to do Doble Bookkeeping. I'd go into full-blown psychosis.
Dr. Garrett Reply:
Sat, May 16, 2020, 2:33 PM
Good thinking, Andrew about not being able to maintain "double bookkeeping."
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