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Mental Health Will they know if I'm off my meds?

Artificial Emotion

Artificial Emotion

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Joined
Jan 19, 2009
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I'm being prescribed clozapine in two weeks time for schizophrenia. I have had an ECG, a FBC blood test and will have to be monitored for a whole day in the actually mental health clinic. Then if all goes well I have to have weekly blood tests testing for agranulocytosis which is condition affecting white blood cells which will eventually go down to monthly.

My question is this - will they know through the blood testing if I ever decide to go off my meds?

I'm being compelled to get treatment by the authorities but they can't force me to take meds if I don't like how they affect me unless I'm in hospital.
 
In general, if you're being compelled by the authorities to seek treatment, then it's in your best interest to follow your treatment protocols. If you're not liking the way a particular med is affecting you, take that up with your doctor and switch to another.
 
Yeah they will check your level. Pretty sure a therapeutic level is around 150 (don't know if it's ppm or what). Also, no offense, but I think your behavior would likely give you away too.

I don't know about you, but I liked clozapine. Seems like it's main active metabolite is a delta-opioid agonist.

Give playing by the rules a good year. Then, if it doesn't work, you can at least say that you gave it a shot.
 
Ho-Chi-Minh said:
Yeah they will check your level. Pretty sure a therapeutic level is around 150 (don't know if it's ppm or what). Also, no offense, but I think your behavior would likely give you away too.

I don't know about you, but I liked clozapine. Seems like it's main active metabolite is a delta-opioid agonist.

Give playing by the rules a good year. Then, if it doesn't work, you can at least say that you gave it a shot.
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Thanks for the reply. I never knew you were schizophrenic like me!

Aren't you confusing it with lithium though? They routinely do that with lithium rather than clozapine, don't they?
 
Yes, they'll know. I understand that you don't like the way it makes you feel, but perhaps sucking it up for a bit, then complaining later will get you better results...
 
Artificial Emotion said:
I'm being compelled to get treatment by the authorities but they can't force me to take meds if I don't like how they affect me unless I'm in hospital.
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Are you on a CTO? I assume you are since you talk about being compelled to get treatment... I guess you know that not complying with your conditions might mean you get recalled to the hospital?

I think the first thing to say is, you haven't tried clozapine yet so don't be so quick to dismiss it. I know from experience that APs aren't the most pleasant medications to be on but you should at least try the clozapine. If you end with unpleasant side effects, then you should bring it up with your doctor to discuss the options rather than risk being hospitalized by not taking your medication.

I think if you refuse to take your medication on a CTO you will referred to a second doctor to assess whether there is a valid clinical basis for doing so. I've never been on one myself, so I'm not entirely sure though.

You can read about the finer points of a CTO, including refusing medication & appealing it, here. (pdf link)

If you're not on a CTO, just ignore this... but as I said, at least try the clozapine first!
 
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No I got a conditional caution from the police and am being forced to seek treatment as a condition of that caution. They don't stipulate that I have to take the meds, just that I have to see the psychiatrist which I did.

I basically attacked someone that was doing some pretty shady stuff and I imagine the crown prosecution service and the police decided that I should get treatment rather than being convicted. I am surprised they took the decision not to prosecute because what I did was pretty bad. I've seen similar stories in the newspapers - that of bad, so I am lucky.
 
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Yes I am, and on my way to a successful career!

My opinion is that if the law is in any way involved, do what the doctors tell you. It can get really ugly, really fast. If you were in any way violent or vengeful, that should be a red flag in my book. Society will crack down on you hard.

I never got in trouble with the law, but looking back, I honestly did things that were so fucking stupid. I needed to be saved from myself (which did happen). Today, I'm the better for it.

For lithium they check levels too, as a therapeutic dose is fairly close to a toxic dose.
 
Artificial Emotion said:
No I got a conditional caution from the police and am being forced to seek treatment as a condition of that caution. They don't stipulate that I have to take the meds, just that I have to see the psychiatrist which I did.
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Ah my bad.

I tend to agree with Ho-Chi-Minh though, I'm not sure if the police will be following up with your psychiatrist but if they do it's best you are following their treatment plan to the tee. As I said, even if the medication is proving troublesome, I'm sure your psychiatrist will listen & make adjustments. The way I see it, the more open & honest you are about your treatment with your psychiatrist, the more likely that they'll get you stable on the right medication.
 
^That's terrible advice. If the OP gets in further trouble down the road, the authorities can check with the psychiatrist to see if he's been following the treatment protocols. The OP at the very least needs to be working with the doctor instead of refusing to cooperate.
 
Agreed, silverwheel.

Not all doctors are insistent on their preferred way of treating patients. That said, if you've proven to be violent in the past, it follows that they'll be more stringent. But both the doctor and patient have their own perspective, and I think many doctors try to integrate the patient's opinion into the treatment.

Refusal will ultimately lead to time served, whether in hospital or jail.
 
Well I cooperated but I eventually ended up in hospital anyway. Today I was admitted into a psychiatric hospital and I'm posting this from my phone while laying on my hospital bed high on the benzodiazepines they gave me.
 
My intuitive take is that if you hadn't taken the medication, things would have been much worse.

Some people go through a couple of hospital stays before getting on the good path.

But I would question what you mean by cooperation. Does that mean taking the medication as prescribed? Does it include going to therapy regularly? And the big one: did you abstain from recreational drugs so that the medication and therapy were actually effective?
 
The blood tests for clozapine measure white blood cell counts, so shouldn't give any indications of whether you're taking your meds or not.

I'd say to give the clozapine a chance, however. I've taken it myself, and (assuming it's dosed properly, much like anything) didn't find it caused any bad side effects, while it did a remarkable job of eliminating my flashbacks and intrusive thoughts/feelings at night so I could get to sleep consistently. I felt it may even have helped me to maintain a better control of my emotions and impulsivity during the day, although the legal and insurance clusterfuck surrounding it meant I wasn't on it for long enough to know for sure.

It's considered a last-resort medication, meaning it won't be prescribed to you unless you've already tried at least two or three other medications beforehand, yet ironically seems to be the most tolerable medication in its class. What other meds have you taken previously, and why were they stopped? What side-effects did you get from them, and at what dose?
 
They also test for the level of clozapine, desmthylclozapine, and the sum of the two, in the bloodstream. If it's not in the therapeutic range, they'll literally raise the dose until it reaches 900mg, at which point it will become painfully clear that you're not taking it, then they might put you on a monthly shot and make sure you take the clozapine to boot.

Yeah its supposed to be very effective even if no other antipyschotics were tried before. I wouldn't exactly call it tolerable though. Clozapine is notorious for sedation and weight gain.
 
Ho-Chi-Minh said:
They also test for the level of clozapine, desmthylclozapine, and the sum of the two, in the bloodstream. If it's not in the therapeutic range, they'll literally raise the dose until it reaches 900mg, at which point it will become painfully clear that you're not taking it, then they might put you on a monthly shot and make sure you take the clozapine to boot.

Yeah its supposed to be very effective even if no other antipyschotics were tried before. I wouldn't exactly call it tolerable though. Clozapine is notorious for sedation and weight gain.
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Perhaps it varies depending on which country you're in? Although I don't really see how measuring the plasma concentration of clozapine or its metabolites can provide any useful information regarding the possible development of agranulocytosis (which would only be revealed by a major anomaly in white blood cell count).

For the short time I took it, it was always at night, so the sedation was a positive aspect for me (having been a chronic insomniac for as long as I can remember). As for weight gain, I wasn't on it long enough to actually notice any effects of that sort, but if it's at all like Seroquel or the tricyclic antidepressants then it isn't that hard to develop methods to minimise and cope with this. Even just opting to take your meds as a single dose in the evening will usually ensure you're asleep long before you'd even start thinking about food, and the feeling of hunger should generally have dissipated by morning.
 
Doubtful.

Similar to lithium, there's a general concentration that most associated with therapeutic effects. My impression is that they want to keep it within that range or the possibility of lowering white blood cell count to a dangerous level is much more likely.

For most, the sedative aspect of clozapine is constant, not just at night. Also, people tend to take it in the morning and at night.

I've taken tons of different medications, including many antipsychotics and other medications notorious for weight gain, but not until clozapine did I gain a huge amount of weight. Of course, your mileage may vary.

It doesn't knock people out like the first two weeks or so. And it wouldn't be effective unless it works on symptoms throughout the day. Hunger will always be ravenously present, in my experience.
 
I'm just having leave today from the mental hospital and they've switched me to aripiprazole with the hope the restlessness goes away after a couple of weeks! Wish me luck :)
 
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