January 02, 2009

Tegrex Takes My Fury Away


It's been roughly a year since I first wrote that Tegrex Makes Me Sleepy, Gives Me Torpor. A year into using Tegrex (carbemazepine), (if it still makes me sleepy and gives me torpor), I don't notice it anymore.

What I have noticed is that the fury that I once felt, the extreme lack of patience and desire to smash something or tell someone to go fuck himself, is gone. Pervasive anger is often a part of untreated depression (or whatever my problem is, at least for me), yet the Tegrex has treated the anger part of my "depression" successfully.

I still have angry thoughts. Over the past week, and periodically since I was seventeen years old, I have been thinking about creating a guillotine of one kind or another (note the one I found to symbolize my mood when I started this blog a year ago) and the idea of cutting my head off is just as present today as it was a year ago.

Lately, having bought a welding machine, and with an account at a store that sells gas-powered chain saws, I've been fantasizing about building a chainsaw-powered guillotine. Actually, I've been fantasizing about this since I was about seventeen years old. Did I say that already?

I would have build a guillotine in my mother's back yard, but I think the neighbors would have seen it, and that would have let loose a cascade of unpredictable consequences, none of which involved me dying in peace on my guillotine.

So, you might say that I'm still furious inside, but without the compulsion to act it out. That makes life more manageable, since in the period before I started taking Tegrex I bashed a marble kitchen sink into five pieces with a wooden chair, for an example. That sort of release felt good and necessary and justified in the moment, but left me with expensive troubles to resolve.

Now, I am investigating the possibility of taking more Tegrex. When I talked to a state psychiatrist and told him that I was only taking 200 milligrams per day (of a potential 1,600 mg maximum dosage), he was notably surprised. "You're not taking 1,600 milligrams?" he asked with shock? But, he was trained back in the 1950's, when psychiatrists considered that an effective dose had been reached when the negative side effects became apparent. More recently, psychiatrists and psychologists believe an effective dose has been reached when the negative affect and behavior goes away, even if the patient doesn't have e.g. facial ticks and obvious torpor caused by the medication.

Now, I'm reading online the patient insert for carbemazepine (which does not come with the medicine when it is provided for free by the Government pharmacy) and the insert says:
The initial dose of 200 to 400 mg per day, should be increased slowly until the achievement of analgesia (in general, 200 mg, 3 to 4 times daily). Then gradually reduce the dosage to the lowest level of maintenance possible. Neurolab
So, I'm only taking the minimum recommended dosage and 25% of the maximum recommended dosage of this medication. Maybe I should take more? Lately I feel great in the morning, singing on the way to wherever I'm going, and by ten o'clock at night I want to walk in front of a semi-trailer. I'm fantasizing about ways to kill myself. These are mood swings that occur on a very rapid basis, like the "rapid cycling" kind of bipolar disorder.

The page says further,
Acute mania and maintenance treatment of bipolar affective disorders: The dose range is 400 to 1,600 mg a day, and the usual dose is 400 to 600 mg a day, in 2 to 3 divided doses. Neurolab
So, I'm taking merely half to a third of the "usual dose", and I'm taking it once a day, in the morning, instead of spreading two or three times as much medicine out over the full day.

I'm going to contact my psychiatrist and propose that I take more, and see what he thinks. Meanwhile, I'm just going to take more on my own and see what happens.

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