OK, usually on here I try to write about my experiences while occasionally serving up some mental health news and presentation of data. Generally I also try not to make overly-arguable points; but here, now, I'm breaking this rhythm - antipsychotic medications cause diabetes. They just do.
Antipsychotics are becoming more and more popular as they are being prescribed for many people outside the traditional market of schizophrenics. Antipsychotics, like Abilify, Zyprexa, and Geodon, are the most profitable class of medication bringing in $14.6 billion in sales last year. Antipsychotics are commonly prescribed for depression and bipolar, and recently have been FDA approved for treatment of children. And they cause diabetes.
Now I'm sure if a drug rep were here right now, they would yell at me, grab a pie chart, and try to sue me into the Stone Age for saying that. But pie charts notwithstanding, people who take antipsychotics suffer from side-effects like: acute dystonias, akathisia, parkinsonism (rigidity and tremor), tardive dyskinesia, tachycardia, hypotension, impotence, lethargy, seizures, intense dreams or nightmares, hyperprolactinaemia, decreased desire, decreases in short-term memory, and yes, a bunch of other stuff. Here it's noted that schitzophrenics have a higher mortality rate partially due to the lethal side-effects of antipsychotic medication.
Obesity and metabolic syndrome, with increased risk of eventual cardiovascular disease and type II diabetes, are significant problems for patients receiving antipsychotic drugs and are likely contribute to their decreased life expectancy.
And in spite of being on many antipsychotics, many times, not one doctor has ever said this to me. Not one doctor has ever said that I would get fat and get diabetes. Not one ever said that I'll likely end up with cardiovascular disease and a decreased life expectancy. Not one ever said to me that these drugs can deprive me of knowing my grandchildren.
Well, OK, I'm not likely to have grandchildren, or children for that matter, but that's not the point; the point is that no one is informing people that these extremely common medications are going to make them fat, sick, and dead. These are important points to know.
And the kicker is, what it so often is: the drug companies know. And your doctors should too. And yet both of them are trying to get these medications into more people's hands, mouths, and brains.
And AstraZeneca is going to pay a paltry $520 million after marketing one of their antipsychotics off-label (without approval) and giving people diabetes. (Those, of course, are the allegations, not findings of fact. They settled out of court. Naturally.)
And just based on personal experience alone, I can say that this is the worst class of drugs, has the most side-effects, and the most severe side-effects. I've gained more weight on these medications than I care to recall, but in addition I have blood pressure issues, heart rate problems, and have experienced psychosis, severe fatigue, headaches, nausea, muscle twitches, chronic runny nose, and passed out thanks to these medications. Not to mention the fact that these medications tend to make me slow and stupid. Not a great combination.
There is no arguing that these medications save lives. They can work for schizophrenics, bipolars, or depressives, and can work in cases where other medications fail, to be sure - I'm not arguing that they don't work. I'm also not arguing that for many people, myself probably included, the possible benefits do outweigh the risks. My problem is simply that -
antipsychotics cause diabetes
- and no one seems willing to say that. But I am saying it. I am saying it here, and I am saying it now: these medications will likely make you fat, might make you diabetic, might hurt your heart, and will likely shorten your life. In addition to everything else that might go wrong.
These drugs might still be the right choice for you, but at least understand what you're getting yourself into; because, heaven knows your doctor and the drug company sure aren't going to be the ones informing you.
There is a recognition among many of us crazies, as well as the professionals that treat us, that most of us do not simple fall into one camp - we're bipolar with a hint of ADD; we have a borderline personality disorder with depressive and psychotic features; we suffer from schizo-affective disorder with post-traumatic stress disorder (PTSD) and addiction mixed in. Humans are complex, and their brains even more so.
And what's more, my depression isn't like your depression. In fact, so much so, that using the same word is almost nonsensical. I sleep 15 hours a day, but you only sleep 3. I have a successful job, but no family or friends. You have neither but participate in online support groups 10 hours a day. I think about killing myself every day but you actually plan for it once a week. You never cry but I cry all the time. Are we the same? Am I more depressed than you, or less?
And things get more complicated when you compare personality disorders and bipolar and ADD and PTSD combined with comorbid conditions like addiction. And yet somehow we're supposed to suss this all out, find a label, and a treatment that goes with it. That's pretty tough.
So some doctors would like not to put people in boxes, but to place them on continuums. You would become a multi-dimentional person, probably with severity ratings attached. So, I might be 80% bipolar, with a severity of 7/10, 10% anxiety, severity 3/10, and 10% PTSD, severity 2/10. (The scales used here are coming out of my head, not from any published source.)
And if you know mentally ill people, and you're educated about disorders, you can see that continuums really do fit more people than boxes do. Boxes are, naturally, self-limiting.
But there are some problems here. Well, too many to count, really. First off, how would you measure how depressed a person is? Or how schizophrenic? Or how bipolar? There are many scales that have been developed for this but there is no standard as none have been proven to be wholly accurate. The scales we do have are more effective at measuring change over time, to tell if you're getting better or worse, than objectively coming up with a score indicating how much you are of something.
And severity. Severity is a personal thing. If I can't work because of a disorder, then naturally that is severe, but it can be just as severe to have nothing in your life but work. Doctors feel that planning your suicide is worse than thinking about suicide but if all you do is think about your death all day long, is that not severe? What if you cut yourself but never really suffer any grace injury, is that severe or not?
It's personal. Severe to me probably isn't the same as it is to you. And it probably isn't the same from doctor to doctor either, so coming up with a measurement is rather difficult.
But even if we could measure how much of an illness you had, and how severe it was, and we could assign you a magic number than represented all of that, what good would it do? It doesn't change the treatments we have available. It still doesn't change the drugs, or the therapies, or the ECT, or the VNS. All that remains. And as it stands now a doctor might prescribe any medication for any disorder anyway so what's the point in being so numerically specific? Whether you're 100% bipolar or 75% with some PTSD doctors are going to try lithium, mood-stabilizers, antipsychotics anyway. It really doesn't matter.
I applaud a system working to recognize that we're all different, and that through standard diagnoses we almost always get it a little bit wrong, but at this point I just don't see a way around it. Mental illness isn't like a burn where you can measure the percentage of skin affected and burn depth. It just isn't that simple. And maybe one day we'll know more and we'll be able to attach numbers to the illness of a brain but unfortunately we're just not there yet. I suspect until we really have a biological way of identifying issues: 25% excess serotonin, not enough dopamine, and so on, we'll be stuck with the muddy mess of trying to categorize a seemingly infinite variations on the human brain. Broad strokes are really the best we can do until not just something better, but something more useful comes along.
I've never been this desperate for a job before. I have a better resume than almost anyone I know, certainly more skills than I've ever had before, and yet still, I can't get anyone to hire me. I went through this while looking for other positions at the Empire too. I would go on six-person interview loops and interview after interview would go well, and they'd pass me onto the next person. I'd finally get to the Big Cheese at the end and we'd talk, and he'd like me. Sometimes we would go well over the allotted time. And yet, no one would make a final commitment.
At the Empire there may have been political motivations that I won't get into, regardless, successful interview after successful interview and yet no one wants me around. I'm personable, witty, smart, persuasive, and in the room I know they like me. And yet, I'm never the one they pick.
And one has to wonder why. Why is it that no matter how good I am no one wants me? No matter how I dress, or charm, or connect. I am not your average candidate - I am better. I understand you thinking that's obscene ego right there, but it isn't. It's just a fact. I'm not a painter, or a football player, or tax auditor, or a mechanic. Those are just facts too.
And so I wonder, if some tiny part in the hind brain of the humans realize that I'm not one of them. I wonder if some little voice they don't recognize and don't understand tells them that I'm just "not the right fit". There's nothing tangibly wrong with me, it's just that something is off.
I can only assume this is what is happening. It happens in my personal life, I suppose it makes sense that it would cross over professionally. The humans have figured out to stay away from me in friendships, and in romance, it's understandable that employers would eventually see it too. Some invisible stain that exists between my eyes, screaming out, to stay away.
And I have to say, as weepy as it sounds, that I really think it's not my fault. I've only done my very best for employers, garnering glowing reviews from people I've worked with, and in my personal life I always try to help, and support, and protect and be kind. But these things, it seems, my very best, it seems, is no where near enough. These things don't make up for whatever it is I'm not seeing. These things don't make up for my deeply embedded flaw.
And yes it's the bipolar. And no it's not the bipolar. And yes it's the way I look. And no it's not the way I look. All those answers are simultaneously right and obviously wrong. But if I woke up tomorrow thin, beautiful, and sane I suspect it would fix my problem.
Or maybe it wouldn't. Maybe every day spent the way I spend my days deepens the stain in ways that can never be erased. Maybe even if I woke up tomorrow a perfect female specimen it wouldn't matter, because all these years of being this person would show throw anyway, an indelible halo of gunmetal pain around me. I don't know. But it's a touch moot as that sort of thing isn't likely to happen.
It seems the older I get the more fucked I am. The more lovers I've spent, the more friends that have left, the more jobs I can't get, the more treatments I've failed, the more doctor's I've seen, the more lies I'm forced to live. This disease is not a fine wine, it doesn't get better with age.
Still I know, whatever the crazy has done, there's still lots of blame to go around that's just mine. Other crazies have loves, and marriages, and careers, and children, and friends, and lives; I just don't. I'm worse than them, or uglier than them, or less desirable, or less lovable, or just less than they are. I don't know how it is I'm less lovable than everyone else, but empirical evidence just seems to say that I am. You just can't argue with the fact that people don't want me.
I don't know what comes next. I don't see the pieces fitting together. I don't see how I'm going to pay rent. It all sucks so much I don't want to look at it anymore. I can't think myself out of this disease and I can't think myself out of this life either. My Big Brain feels about as useful as a door stop, right about now. Well, OK, less, because my brain would get the floor all dirty.
I have bipolar-disorder-type-II-rapid-cycling. I diagnosed myself when I was 20 years old, and once I finally agreed to see a doctor, he agreed sometime thereafter. My diagnosis was fairly easy for me. I'm very self-aware and I could pick out discrete moods and swings. But as a 20-year-old, in university, using research, and having a fairly high IQ, this is not terribly surprising. If I were five-years-old, the picture would have been a little different.
There is an epidemic of children, as young as two, being diagnosed with psychiatric disorders in North American right now. It's made the cover of Time magazine and countless articles have been written on the phenomenon.
It was once thought that disorders like bipolar did not occur before adulthood, but thoughts on this seem to be changing as diagnoses go up and more drugs are approved for treatment of children. Seroquel, Zyprexa and Geodon (all antipsychotics), now have FDA approval for pediatric use, and of course, doctors are free to prescribe any medication off-label.
I have been on all three of those antipsychotics and all three have fucked me up. Specifically seen has been weight gain, blood pressure changes, twitching, extreme fatigue, incurable hunger, and in the case of Geodon, psychosis. Among other things.
Antipsychotics turn down the dopamine in your brain. That's what's the do. They also turn down serotonin. These are two of the "feel good" chemicals in your brain, and you are turning these down. This seems to help with certain disorders like schizophrenia, but dopamine in integral for motivation, reinforcement, learning, and memory. If, for example, your five-year-old eats his peas, and you praise him, he feels good because a shot of dopamine is released. This then reinforces the pea-eating behavior, so that next time, he will again eat his peas. If you take away dopamine, he may not be able to make this link. And if you take away dopamine from a child's (naturally developing) brain for a long period of time, no one has any idea what would happen.
I cannot, in any world, imagine giving these drugs to a child.
The truth is, no one knows what bipolar looks like in a child, or if it even exists. Psychiatrists are using relaxed versions of symptoms seen in adults for diagnoses. This is patently ridiculous.
Recently a friend of mine was talking about a girl who hallucinated a dead robot baby. Moreover, this same girl spent her recent birthday having an elaborate funeral for a bird found dead in her back yard. Sound crazy? Not for a seven-year-old. It might be a bit unusual, but to me this speaks of intelligence creativity and compassion, not a mental disorder.
Kids blur the line between fantasy and reality. Kids act out. Kids throw tantrums. Kids ignore you. Kids break rules. Kids often don't show a great regard for their safety or the safety of others. Kids throw broccoli across the kitchen table. Kids do, the darndest things. They're kids. It's what they do. None of this makes them crazy.
And let's face it, some kids are very challenging to handle. Some are overly aggressive, or sad, or obstinate. They hit their sister, break a vase, or refuse to stay in their room for a time-out. This still doesn't make them crazy, this just makes them challenging. Parents don't get a pass just because their job is harder than they thought it was going to be.
Basically, kids can have almost any pattern of behavior and still be pretty darn normal. And that doesn't take into account all of the environment factors that are effecting kid's behaviors. I've never seen great parents with a kid with huge behavioral problems. Yes, I'm sure it happens, but generally, kids are a reflection of their home lives. And kids with bad home lives don't need or deserve drugs. They deserve better home lives.
And on top of all of this, if a child really is having behavioral problems there are specialists who can help with that, they're called child psychologists. They help children and parents all day long. And they don't cause weight gain and high blood pressure.
And don't get me started on how idiotic it is to diagnose a two-year-old with a mental disorder. Two? Really? It can take an adult two years for an adult to get a diagnosis of bipolar. That sounds like a parent disorder if ever I heard of it.
It feels to me like these children are being treated as lab subjects, and not real people. I am highly suspicious of any doctor that would medicate a child. Could it possibly be a reasonable thing to do? Well, maybe. But you'd be hard pressed to convince me.
And in addition to whatever drugs are being fed to these children, they are also being saddled with a diagnosis - for the rest of their lives. As an adult it can be extremely detrimental to be labeled "crazy", but as a child I can only imagine it would be infinitely worse. These children don't even have a chance to find an identity before they're told they're crazy. How can that label not result in self-fulfillment?
When the movie "Cybil", based on a woman with multiple personality disorder, came out, the diagnosis of this disorder exploded across the US. A disorder that had virtually never been seen was suddenly everywhere. But over the decades that followed, medical professionals were able to determine that these were not genuine cases. In fact, some doctors feel that there has never been a documented case of "multiple personality disorder" as featured in the film. There are other disorders with similar features, but the giant outbreak seen after the film, just didn't exist.
And one has to wonder if we're seeing something similar here. If more adults are being diagnosed as bipolar, then naturally, we are looking for markers of it at younger ages, and in their genes. We want this information to help people, to help treat the disease, but it can just as easily be used to further label people before we even know how to do it properly. Multiple personality disorder looked like a correct diagnosis until we figured out it wasn't.
And if someone as young as a toddler gets diagnosed with some behavioral disorder, don't these children deserve time to correct this issue via safer methods than drugs? It seems that out of an eight year life, it's impossible that enough other treatments have been tried to warrant drugs.
Now, it's true, I'm not a doctor, or a parent. And I do have a strongly held belief that doctors and their patients should be able to choose treatments without judgment from the outside world. But I also think that any doctor worth seeing is going to try the least harmful treatment first, especially in a population that has been radically understudied. True, behavioral therapy might not work, but it's unlikely to cause debilitating side-effects. And what about waiting for a child to grow out of behavioral issues? I hear that was a thing that used to happen. Before we got all diagnos-y.
I'm not suggesting that no one under 18 is sick, or that no one under 18 should be treated with medication. What I am suggesting is that diagnosis and treatment of children needs to be handled with extreme care and caution. I'm an adult and I give informed consent to fuck with my brain; children do not have that ability, and yet, they will be the ones that have to live with the results. They deserve every possible solution that avoids nasty, unknown side effects. Parents need to be held to a higher standard of decision-making and not pick what is easiest for them, but what is best for their child. Doctors need to be held to a higher standard to care with children, ideally with third party monitoring of underage drug-treatment. This is not something to be taken lightly on any front.
Someone needs to sanity-check the parents. Kids need to be able to act crazy, without getting labeled crazy.
I want to believe that what we have is special. I want to believe that it means something. I want to believe it's unique. I want to think that you cherish it as much as I do.
I want to think that I couldn't just be replaced with a curvy 26-year-old. But that's probably not true.
I've cared for so many people over the years. Lovers, friends, all manner of relationships. And often, I consider these bonds to be unique. Irreplaceable. You can't just swap out one person for another. I want to be with a particular person, not just any person. No, another cute, curly-haired, freckled, kinky girl cannot take another girl's place. It's just not possible. Bonds are unique.
Except when they're not, I suppose.
I am a pretty unique gal. No, not always in a good way, often in a bad way, but unique nonetheless. Being in a room with me is a different experience to most. Discourse is different. Sex is different. The oxygen is different. Yes, I'm different down to a molecular level. Which we all are, of course, I'm just different-er.
And I really want to believe that the few bonds I share with people are special. I do believe it. Sort of. Sometimes.
But people keep proving to me that I'm expendable. That they can get rid of me without a word. That I mean that little.
We all get expent. I know we do. But I find it so hard to create any bond with anyone that losing one, to me, feels like losing the ability to breathe.
I hate myself. And proof that I'm expendable just encourages that hatred and proves that it is right.
If you live in the US, you've probably seen all the commercials for the new and pastel-coloured Pristiq. It has a huge marketing push behind it and is an selective serotonin norepinephrine reuptake inhibitor (SNRI). In other words, it works on both serotonin and norepinephrine. neurotransmitters. It is not the only drug to do this, but it is a smaller class than those that just effect serotonin alone (like Prozac).
What you might not know, is that the same company that makes Pristiq also makes Effexor, which is an almost identical drug, that has recently become available in generic form (Venlafaxine). Pristiq, O-desmethylvenlafaxine, is actually the main metabolite of Effexor, venlafaxine hydrochloride. This means that if you take Effexor, your body breaks it down into Pristiq, and other chemicals.
For this reason, some people say that Pristiq is nothing but a "patent extender". In other words, their patent ran out on one drug and so they patent another, almost identical, drug to keep up their profits.
This, is probably true. If I were a company exec, I would understand that this is an easy way to make money.
And some doctors are claiming that Pristiq should simply be "forgotten about".
The thing is, they are not the same drug. A metabolite is not the same this as the initial compound. When you take Effexor your body metabolizes it into Pristiq and other stuff. That "other stuff" might be good for you, or it might not. It depends on who you are. We all have different needs and chemistries.
But what I think can't be argued is the fact that Pristiq has to, by definition, have fewer side-effects on the whole than Effexor. For an individual person this may or may not be true, but overall it has to be because Effexor contains more compounds.
Regardless though, even if these two drugs are very similar, some people will respond to Pristiq that did not respond or could not tolerate the side-effects of Effexor. This is a certainty. We are all so different that it is obviously true that some people will have this response. And quite frankly, Effexor has a lot of side-effect and withdrawal issues associated with it, so it wouldn't surprise me if even a slightly cleaner version would be better tolerated.
And most importantly, if you fall into the category of people who are helped with Pristiq, who were not helped with Effexor, you really don't give a shit about patents, metabolites, profits, or self-righteous doctors. You just care that you're being helped. And that's really all that you and your doctor should care about.
And that group of people is precisely why doctors should not forget about Pristiq, or any other drug. Humans are unique and many of us are very difficult to treat, and removing tools from the doctor's tool belt just because they upset some self-righteous doctor's situationally convenient morals, is ridiculous. Is the pharmaceutical company just looking for profits? Yes, of course they are. Is there first concern helping people? No, it probably isn't. Are the research numbers on Pristiq stunning? Not really. But if you're in the group of people helped by this drug, you don't care.
Those of us who have been at this a while know that it's all a crap shoot anyway, so why take away an option that might get you better? It's just a stupid thing to do.
[Note #1: All that being said, if you're successful on Effexor, don't just switch to Pristiq, those other chemicals in Effexor might be the ones helping you. No one can predict whether you'll have the same reaction to Pristiq. If something is working - don't mess with it!
Note #2: I'm not endorsing either drug here, just suggesting not ruling them out.
Note #3: Pristiq isn't my favorite medication. It has absolutely brutal withdrawal symptoms that (for me) kick in within two hours of expected dosing time. I gather this also happens with Effexor, and Effexor's withdrawal effects tend to be even worse.]
As you might have noticed, I've been writing about bipolar for a really long time. Seven years in internet time is a lifetime or so.
And in all that time, in addition to the writing, I've been doing reading, or more commonly, researching. I've been looking up information on disorders, medications, treatments, supplements, and a whole manner of other matters. This is because I like to be educated about my disorder and my treatments. I often share that information because I think others should be educated too. I strive to make anything I write accurate and provide links to reputable sources.
But what information should you trust? Should you trust me, a random blogger? People on discussion groups? Information sites? Drug company sites? Doctor sites?
Pretty much, almost always, no.
Here are a few ideas about trusting information online:
Do not make any decisions about your health or treatment without talking to a real, live doctor in person. Period. You can take all the self-assessment questionnaires you want, but you can't pick a treatment or a diagnosis without the help of a professional. These tools can help you bring information to your doctor, but nothing is a substitution for a real professional.
If you can't check out a person's credentials, don't trust them. Anyone can claim to be a doctor, or a nurse, or have a Phd, but that doesn't mean they aren't actually a teenage mosquito trainer practicing pirouettes in a tent in rural Lesotho. If someone is offering you professional advice, they should have no problem supplying their credentials. One of the reasons I love Jim Phelps' site is the fact that he is forthright about who he is, and how he's funded.
Check how a site is funded. If a site doesn't tell you who's supporting it, who's funding it, and where the information comes from don't trust them. As a general rule, sites funded by drug companies or special interest groups should be treated with extreme suspicion. Special interest groups can include religious groups and even some charities. While they may have good intentions it's likely their information is slanted and partial.
If there are no links to actual data or studies approach with extreme caution. I could be a doctor making the claim that carrots cure depression, and that might be a very appealing claim to a lot of people as anyone can buy carrots, and I can even say that "I've seen it work over and over" but if I can't back that up with real scientific data, then the claim holds no water. (That being said, there's no harm in asking your real-life doctor about carrots, or anything else, even if it is questionable. That's what they're paid for.)
Any referenced study must be published in a reputable journal. Psychology Today is a magazine not a journal, the Journal of Clinical Pharmacology is a reputable journal. Real studies are listed here and are published in peer-reviewed journals. Also, in reputable studies any conflicts of interest must be disclosed. Implications from research can be confusing so print out the study and ask your doctor about it. Some groups are really good at making information look authentic but if it wasn't published in a reputable peer-reviewed journal, it's not to be trusted.
About.com's Nancy Schimelpfening suggests that HONcode accreditation is also a good thing to look for, but honestly, I've never heard of it and can't say whether it's reliable.
I have to stress, there are many medical sites out there that are trying to sell you a product or idea. Please keep in mind that there are some groups that are very anti-psychiatry and anti-medication and try to push that agenda. They masquerade as self-help sites, discussion groups, individuals on discussion groups, and drug rehabilitation/addiction sites. There are people pushing products that do the same thing.
I get marketing bots here too, (like automated comments that direct a reader to a drug-site) but I do my best to remove them as soon as they show up.
Be skeptical. If it doesn't sound right, ask a professional. Please don't let random online weirdo's make choices for you or influence how you feel about yourself and your disorder. You're better than that.
[And just for the record, I don't portend to be anyone other than a mouthy bipolar with a lot of tears, screams, and things to say. I'm pretty smart and try to help people, but that's about it. Oh, and I'm funded by no one. Just ask my landlord.]
OK, there's something wrong with the blog template. I have no idea what it is. I've looked, and looked, and I've been writing, and crying, and I'm tired, and I don't know.
That's what you get for using beta features, I guess.
Update: Nope, still can't figure it out.... might have to change the template...
I sort of hate people. Well, normal people. Well, normal, happy people. I hate them.
On second thought, I hate normal sad people too. Because they will be happy in the future. That's enough to make me hate them now.
It's jealousy, of course. It's not so much that I hate them, it's that I hate that I can't be them. And they're all around me, all the time, reminding me that I can't. It's hard not to hate those people.
I went to a walk-in clinic today to get a script for a couple of meds I'm out of. I'm continuing to wait to be seen by an actual psychiatrist. Here, it's so tough to see one, I've had to get a referral, file it with mental health people, talk to them, they sent me a form to get my records from the US, I signed it and sent it back, and now I'm waiting to hear back from them to see if I'm crazy enough to see someone.
So the doctor today asked me "how it was going". It's a cursory due diligence done for the crazy. And I told him that the verapamil seems to have induces some cycling although that seems to have leveled off and I'm hugely anxious, which I think also has to do with the verapamil. The doctor suggested I call the mental health people and see someone sooner. That's his advice? Really? Because I didn't want to break it to this guy but likely whomever I see, they're not going to know what to tell me about my meds either. Someone is going to actually have to do some work. Like, look stuff up and shit. Or talk to other doctors. Or something. Is it better than no advice at all? Maybe. But just barely. It's the same advice I would get from a random person over the internet too. Not a guy with a medical degree. How many years did it take him to get that? Oh yes, 10.
So, reviewing available data and personal experience, the anxiety might also be from the Pristiq. Or the Nuvigil. I could reduce the Pristiq as I'm not sure the dose increase from 50 to 100mg was helpful, and the literature suggests it isn't, but the thing about that is that the withdrawal is SO horrific, that I'd be really concerned about it. And the Nuvigil is a switch from Provigil as Provigil isn't available in Canada. They're are supposed to be basically the same, but "basically" is not the same. Anyone who has been switched onto a generic can attest to such things. And changing from the Verapamil in the US to the Verapamil in Canada cause cycling. Don't know why. Can't explain it. Differences in formulation, obviously. A doctor probably would probably have no idea anyway.
I could have requested a benzo to take the edge off but I don't really prefer making myself even slower and stupider. And impaired. And besides, benzos have a reputation of being addictive so doctors look at you funny if you ask for them. They don't like that. Oh, and I have a bunch of them under my sink already. I tend to hoard meds. You never know when you're going to need a really long nap. (Um, no, don't do that. I'm an idiot. Don't follow my lead.)
I'm aware that the anxiety and the anger and the self-harmy desires are from the meds. I know. I just don't know how to fix it. And I seriously have doubts as to whether any psychiatrist I'm assigned to would know either. My combinations tend to baffle. Some of my meds doctors have never even heard of. Pharmacists haven't heard of. Infinitely frustrating. One might think that being forced to act as your own doctor would be empowering. But it isn't. It just feels like chemical roulette. Decisions made with a tiny percentage of the data required to really make a good decision is just a guess. And in this case the guess has a bet attached to it. An expensive one. The table limit is more than most of us can afford.
ATLANTA--(BUSINESS WIRE)--Mar 30, 2010 - NeurOp Corporation today announced a collaboration with Bristol-Myers Squibb Company (NYSE: BMY) focused upon the development of NeurOp's proprietary small molecules for use in the treatment of major depression and other central nervous system disorders.
...The compound class to be developed comprises NR2B subunit-specific N-methyl-D-aspartate (NMDA) receptor antagonists.
I'm not a doctor, or even someone who got A's in chemistry, but here's what I think this means:
NMDA receptors are involved in pain, and antagonists can block pain (like Ketamine, aka Special K, club drug, horse tranquilizer)
There are modern theories that link physical and psychological pain. It is notable that physical pain will make mental pain worse, and the opposite is also true
The NMDA receptor (NMDAR) is a glutamate receptor and "is the predominant molecular device for controlling synaptic plasticity and memory function" - synaptic plasticity is important as without it your brain cells can die
An NMDAR antagonist should then turn down glutamate, and thus calcium, among other things (I'm not saying here that calcium is the only thing being manipulated, or even that calcium is the most important part, there is just a relationship there.)
Glutamate is also a GABA precursor (another neurotransmitter).
Of course if you turn down glutamate, that would turn down GABA, which would turn up many other systems. So maybe that's a thing.
So, I'm excited. Basically because, even if you ignore the above, you're left with the fact that there is a company that is trying to treat depression outside of manipulating serotonin, dopamine, and norepinephrine. And I've been waiting for that.
