The Case of the Missed Dose

It was just a typical day at work. The script count was decent, the pace was comfortably fast, and there were no customer service issues. After a brisk 12 hours, I got home, changed into my pajamas, ate dinner, and looked forward to a solid night’s sleep. When midnight rolled around, and I was still wide awake, I felt the possibility of an all-nighter coming on.

Every hour I did the countdown. If I fall asleep now, I’ll get 5 hours of sleep. When it got down to 1 hour, I realized that a quick nap would do more damage than good, and got up. I didn’t understand why this happened. I wasn’t ruminating on a single thought or nervous about anything; I just didn’t sleep.

I had coffee and that was a horrible mistake. I took my morning meds early just to quell the energy overload that was going on in my body. I didn’t immediately feel any relief.

Thankfully, I had an appointment with my therapist. I was hoping a psychological purge would get me into a lower energy state. Within seconds of seeing me, my therapist knew something was up. He asked me on a scale of 1 to 10, 10 being in the hospital, where I was. I said 8.5.

I didn’t think it was so bad because I wasn’t a 10. He felt otherwise. He asked me every question he could in an hour and nothing in my life was indicative of a cause for the mania. Instead of getting better in the session, I got worse. I was rambling and shaking. I didn’t like it at all.

I told my therapist not to worry, that it was a fluke, and after a good crash, I’d be okay. I got home and took a 2-hour nap. While I didn’t feel totally reset, I felt 80% better. A visit to the hospital was no longer in my future.

I muddled through the day and was thrilled when it was nighttime. I went to bed and was out before my head hit the pillow. I woke the next morning, and all systems were up and running within normal limits. I was totally relieved.

A few nights later, I discovered the cause of my sleepless night. When I went to pack my case of night meds, I saw that my ziprasidone was still stuck in my pill box. The medication I take to stay out of a manic state was sitting right there. It was a total rookie mistake. I should have checked it that night.

I learned 2 lessons from that experience. First, even though I’m a pharmacist, I’m just as capable of making a dosing error on myself as anybody else. Second, even though they’re not controlled substances, I’m chemically dependent on my psych meds. My psychiatric care is a carefully monitored, necessary addiction—but an addiction nonetheless.