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Posts Tagged ‘perscription drugs’

When you think like a designer, when you are willing to ask the questions, when you realize that life is always about designing something that has never existed before, then your life can sparkle in a way that you could never have imagined.

designing-your-life

It’s been six years since I last posted something here. Inertia is a BITCH!

Life has taken a lot of twists and turns since then. I finally moved away from Northern California (and that damned mechanical turkey) (see my Nov. 24, 2009 post “Giving Thanks for an Epiphany“) and relocated to the East Coast. I’ve also begun to experiment with pharmaceuticals again, which I am not happy about. But with all of the stress that comes along with moving, and aging, etc., I felt that it was time to reach out to some new doctors and see if there were any new pills worth popping in an effort to stop a downward spiral. Yes. And no.

For a few months I was on and off some medications I had tried before. Since I couldn’t remember what I had taken, how many milligrams, and in what combination with what, I let the doctor convince me to try things I had already tried, like Abilify and Wellbutrin. When there was no luck with those, he was convinced that I would see some relief with Latuda, a drug I had never tried before but which I was aware of thanks to Sunovion‘s unrelenting TV advertisements. Since it seemed to be working for everyone else, why not me? Well, I don’t think I took it long enough to find out. I had to stop it cold turkey because it was making me want to crawl out of my skin. There’s an actual term for that side-effect. It’s Akathisia, which is also something I was quite familiar with.

On to a new doctor. And here I am, starting my second week with Rexulti, and upping the dosage from 1mg to 2mg.

I’ve also been seeing a counselor/therapist of sorts who has been trying to get me to try things like DBT (Dialectical Behavior Therapy). (He confessed last week that he didn’t think DBT would necessarily do me any good, but that having to adhere to the schedule might.) He also wondered, out loud, if perhaps my expectations were too high. “No,” I replied immediately. It wasn’t something I had to think about. “I’m trying to get from black to grey,” I said, “so, no, I don’t think my expectations are too high.”

Anyway, I’m at my desk writing again, so that’s something. And I feel it’s the only thing that keeps me sane, keeps me committed. The unexamined life is not worth living. But then neither is the over-examined life. But just by sitting at my computer THINKING about what works and what doesn’t, encourages me to keep trying. To re-establish all of those daily activities that have some impact, however small, on my mood-swings or depression; like eating right and exercising. And writing. So even if this new drug doesn’t work, I’m fairly certain it will be the last one I try, so I’m going to need something else to fall back on.

Be well, Marco

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Does Abilify Cause Weight Gain?: Weight gain is a common side effect of Abilify® (aripiprazole). In studies, the exact percentage of people that gained a significant amount of weight varied from study to study, but most studies consistently showed that people taking Abilify were more likely to gain weight than people taking a placebo (a “sugar pill” with no active ingredient).

For two and a half weeks I’ve been following the advice of Timothy Ferriss. He has after all practically guaranteed (money back?) that if I follow his plan I’ll be down to 8 percent body fat in just a few days. Okay, so maybe I’m exaggerating, a little, but dammit, if I’m going to survive on a diet of lentils, kidney beans, tuna and eggs, I want results. And I want them NOW.

And doesn’t a plan for only four-hours a week of anything seem like the perfect fit for someone who’s bipolar and has ADD? In fact, it feels like it’s taken me four-hours just to write this much of the blog. Why are we so impatient? Honestly, I can handle all of the mood swings, the delirious highs and the bone crushing lows, but the boredom, the impatience, and the irritability makes me, well…crazy. Or is it the other way round?

The main reason for my frustration with Mr. Ferriss’ claims is that, not only have I not lost any weight or dropped any percentage points in body fat, I’ve actually GAINED weight and girth.

And then I had a realization. About the same time that I started the “diet” (eating plan, life style, or whatever he wants to call it,) I also started taking ABILIFY® (aripiprazole).

Now, anyone who’s read this blog before, knows full well that I don’t do drugs. Been there, done that. That was the whole purpose of this blog when it began: exploring living a bipolar life without pharmaceuticals.

But here’s the thing: I reached a low point where I just needed something, anything. And vodka, while I’ve used it judiciously in the past, wasn’t going to cut it. At least not for the long term. Of all of the hundreds of medications I’ve tried over the years, Abilify was the only one that worked, albeit for a short period of time. So, while I was hesitant to begin ingesting toxic chemicals into my bloodstream once again, when you’re on the Titanic, and the water is rushing up to your chest, you grasp at anything that resembles a floatation device.

And so it occurred to me today that it was probably the medication that was keeping the weight on in spite of my dedication to the 4-Hour Body plan, right down to the blueberry pancakes smothered in maple syrup and the half-pint of Ben & Jerry’s New York Super Fudge Chunk on those glorious cheat days.

So here is the sad truth about being bipolar: You can’t win.

But don’t you think that with all of that running and running just to stay in place that I’d have lost at least one of those extra pounds?

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Many people today are infatuated with the biological determinants of things. They find compelling the idea that moods, tastes, preferences, and behaviors can be explained by genes, or by natural selection, or by brain amines (even though these explanations are almost always circular: if we do x, it must be because we have been selected to do x). People like to be able to say, I’m just an organism, and my depression is just a chemical thing, so, of the three ways of considering my condition, I choose the biological. People do say this. The question to ask them is, Who is the “I” that is making this choice? Is that your biology talking, too?” The New Yorker, March 1, 2010: HEAD CASE: Can psychiatry be a science? by Louis Menand

I seem to have been in a downward spiral for the past few months. Thus the lack of postings. Miss me?

I can blame it on a lot of things. The weather. The news. The economy. Dick Cheney. The fact that I am forced to deal with bad brain chemistry without the aid of medication.

But whatever the cause, my depression, and the cause du jour, is not a CHOICE.

Yes, the pharmaceutical companies have gone astray and led their Mercedes Benz—home in the Hamptons—trips to Paris aspiring doctors along with them.

I don’t have a problem with people taking Paxil for shyness, Xanax for anxiety, or Wellbutrin for weight loss. But I do have a problem with people assuming that whatever it is that I take (used to take, actually) is a cop-out.

The decision to handle mental conditions biologically is as moral a decision as any other. It is a time-honored one, too. Human beings have always tried to cure psychological disorders through the body. In the Hippocratic tradition, melancholics were advised to drink white wine, in order to counteract the black bile. (This remains an option.) Some people feel an instinctive aversion to treating psychological states with pills, but no one would think it inappropriate to advise a depressed or anxious person to try exercise or meditation.”

For the record, there are those of us who are treatment resistant. But even if you’re not, why would anyone assume that you would choose to take a prescription medication if you didn’t have to?

Yes, we have entered the age of pharmaceutical advertising (TV, magazines, billboards) in which even the most obscure diseases and disorders are woven into our subconscious minds. Come to think of it, my legs do tingle from time to time—maybe I should be taking something for restless leg syndrome. I’ve also noticed I’ve been a little gassy lately—I’ll just bet I’ve got me a mild case of GERD. And even though I’ve no idea what Fibromyalgia or COPD are, according to recent commercials I have a number of symptoms for both, so…yeah, I’m going to self-diagnose (since that’s what those advertisements seem to be about anyway, and it doesn’t seem all that risky when you consider that “…psychiatrists reached the same diagnosis only twenty per cent of the time…”) and demand my doctor prescribe an assortment of pills and caplets for me to ingest that may or may not work, but that will certainly cause dizziness, nausea, constipation, tremors, dry mouth, blurred vision, weight gain, diminished libido (which in all fairness, may be attributable to the weight gain) and suicidal thoughts. Yeah, give me some of that.

Exercise? Diet? Meditation? All good options. IF you can drag your sorry ass out of bed.

We seem to be living in a very strange time (but then, when haven’t we?). Scientists discovered (in many cases, accidentally) that some drugs had a positive effect, on certain psychological disorders, in a few people, under certain circumstances. And, this being America, land of opportunity and quick fixes, we of course decided to take it one step further. Why feel good when you can feel great? My girlfriend just dumped me—give me a pill. My stock portfolio is in the toilet—better take a capsule. My favorite sitcom just got canceled—better up my dosage.

You know what, that’s what cocaine is for, not Prozac. And quite frankly, cocaine (the few times I consumed it years ago) did more for me than Abilify, Prozac, Zoloft and all of the others combined. WITHOUT impinging on my libido.

For those of you who are suffering from symptoms that are far more profound and harder to treat, and find any kind of relief at all in pharmaceuticals, I am truly happy for you. Whatever relieves you from some of the horrible effects and consequences of depression or bipolar disorder, ADHD or OCD, go for it. And I promise you, even though it’s not for me, I won’t be one of those people standing on the side-lines accusing you of copping out.

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“…studies show that the worse side effects a patient experiences, the more effective the drug. Patients apparently think, this drug is so strong it’s making me vomit and hate sex, so it must be strong enough to lift my depression. In clinical-trial patients who figure out they’re receiving the drug and not the inert pill, expectations soar. That matters because belief in the power of a medical treatment can be self-fulfilling (that’s the basis of the placebo effect).”

Perhaps I should explain the title of this post.

You’re all familiar with the philosophical riddle, “If a tree falls in a forest and no one is around to hear it, does it make a sound?” Well, an article in the February 8, 2010 issue of Newsweek magazine (“The Depressing News About Antidepressants,” by Sharon Begley) about antidepressants had me wondering; if a pill that is swallowed that is basically sugar, with no chemical component that might effect serotonin, works because we “believe” it works…does it “really” work?

“…scientists who study depression and the drugs that treat it are concluding…that antidepressants are basically expensive Tic Tacs.”

I’m a firm believer in the power of the mind. I’ve witnessed first hand how thinking can make it so. I do believe that, in some instances, there is such a thing as a self-fulfilling prophecy. BUT…

But, the chances of it working are about as good as your chances at the blackjack table in Vegas. Sure, sometimes you’ll draw an ace and a jack, and sometimes people get better because they believe they will, but not always. If just wishing could make it so, I’d have a brand new Maserati (GranCabrio convertible in Blu Oceano with a Sabbia interior) sitting in my driveway.

Here’s another question I had after reading the article: What happens to the placebo effect after people read an article like this one? Great! Now the pills that don’t really work, really don’t work because we’ve lost faith in them. Now what do we do?

The power of positive thinking has its place. In fact, it wouldn’t hurt to practice that in your daily life, pills or no pills. Accentuate the positive, as they say. But also, be realistic. But wait, how can you be realistic and hope to cure your depression with blind faith?

But then again…I’ll bet there are a number of Pharmaceutical sales reps out there who do have Maseratis in their garages because they visualized them. Because they held a picture of them in their mind and repeated a mantra over an over again while they fudged the test results and made promises to general practitioners that the pills couldn’t possibly deliver.

If placebos can make people better, then depression can be treated without drugs that come with serious side effects, not to mention costs.”

Hey, it’s worth a try. If you wouldn’t mind, I’d like to try an experiment of my own. Here’s a photo of the car.

If you would just stare at it for a few minutes and repeat over and over, “A Maserati in Marco’s driveway,” I’ll let you know what happens. If I go out there tomorrow and there’s a blue convertible, I’ll be first in line to refill my prescription for Zoloft.

But until then, I’m remaining drug free!!!!

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Comfortably Numb by Barber“[Major depression is] immediately detectable to people who know what they are doing. It is an advanced psychological state of despair that one can see in the patient’s eyes, in their slow movements, in the sense that they are in physical pain…” “There is no covering up; they exude naked and pure pain, like a wounded animal. There is absolutely no pretending that everything is okay. All pretense of normalcy goes out the window.” “Comfortably Numb: How Psychiatry is Medicating a Nation,” by Charles Barber

The title is not exactly true.  I’m not really apathetic.  I’m hopeless.

Anyone who’s ever studied depression has come across the maxim: depression is anger turned inwards.  I beg to differ.  I believe that the major cause of depression is the loss of hope.

Anger is a feeling.  Depression is about the loss of feeling.  I know.  I’m in it right now.

I can’t write to save my life.  Nothing matters.  And if there is anger, perhaps it’s caused by the hopelessness.  A dozen topics swirl through my head but I can’t choose one to write about.  None of them matter.  Nothing I have to say on the subject will make any difference to me or to anyone else.  I don’t matter.  And that makes me feel hopeless, which, yes, makes me feel angry (but not the other way round.)

If given a choice between angry and hopeless, I’ll take angry.  Part of that is not a choice but a symptom of being bipolar, irritability, which can easily escalate into anger.

I watched it happen this past weekend over something stupid: a walk with the dog.  My ADD was acting up and while I was doing my best to get ready and out of the house, my partner got impatient.  He made a couple of comments (and a few exasperated facial expressions) and a switch was flipped in my head.  Literally an on/off switch.  I got as angry as a person can get and I refused to go.  And there was no turning back, nothing he could say or do that would change my mind, that could fix it, that could flip the switch the other way.  I became “invested” in my anger.

I have seen that over the years, that willingness to “cut off my nose to spite my face.”  Why?  Because the anger feels good.  It feels great.  It’s HELL, but it’s better than apathy.  If you’ve been walking around like a zombie for weeks or months, the opportunity to feel anything is a welcome respite.  And anger can be delicious.  Intoxicating.

I spent the rest of that day by myself nursing that anger.  Not because I wanted to, but because I couldn’t control it.

I think suicidal thoughts are like that too, when you suffer from chronic depression.  For me, suicidal thoughts were never so much thoughts of suicide, but the idea that, if it ever “really got bad,” there was an option.  Just knowing that I could end it if I needed to was like having Xanax in my side pocket (knowing it’s there can reduce the anxiety and thus the need to take it.)

I always looked at suicide as a free-floating life raft, never seriously contemplating it because it was always there in my side pocket.  But ever since taking Lamictal*, another switch has been flipped, one that put suicide on the table as a real option.  It’s like those images—vase/face or young woman/old woman.

Rubin vase:face

Old woman:young woman

Once you’ve seen both you can never go back to seeing only one.  And once you’ve seen suicide as a real-life (pun not intended) tangible option, a way out of the hell that you are in, you can’t go back to pretending it isn’t.  You can’t go back to the day when taking your own life was like a pill in your pocket because you’ve tasted the sense of relief lingering in those thoughts.

Today I am stuck in a state of mind(s) I’ve been in for a couple of weeks now, somewhere between hopeless, depressed, angry and suicidal.  And occasionally manic.  Thank God (I can’t believe I’m saying this) for mania, otherwise it might have been several more weeks before I was able to make another post.  So please pardon my brain-dump, but I felt that after a two-week hiatus, a rambling, nonsensical post was better than none.  And I wanted to make sure that those kind people who worry about me when I disappear for a period of time know that I’m still kicking.  Thank you for your support.  You are the reason I got out of bed today.

*Note: From the Lamictal website: “Like other antiepileptic drugs, LAMICTAL may cause suicidal thoughts or actions in a very small number of people, about 1 in 500.”

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The Atlantic“…depression turned out to be a major drain on physical health: of the men who were diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63.”  “What Makes Us Happy?” by Joshua Wolf Shenk / The Atlantic, June 2009 

 

Woody Allen opens the movie, “Annie Hall,” with an old joke:  “Two elderly women are at a Catskill mountain resort and one of them says, ‘Boy, the food at this place is really terrible.’  And the other one says, ‘Yeah, I know.  And such small portions.’” 

That sort of sums up how I feel about the prospect of dying early from depression.  “Life really sucked.  Too bad it was so short.” 

In the late 1930’s researchers at Harvard began a longitudinal study of 268 college students that would go on for 72 years.  Through interviews and questionnaires they were hoping to find the formula for a/the “good life.”  In the June edition of The Atlantic, Joshua Wolf Shenk shares with readers, for the first time, information contained in documents used to support this study. 

I have to admit, this wasn’t the first time I had heard about how depression can shorten a person’s life span.  The first time occurred while I was sitting in the small, grey cubicle of Caesar C., my Farmer’s Insurance agent, trying to purchase a whole life policy.  At the time, Caesar was unable to explain to me in a way that I could understand, why the rates were astronomical.  In fact, I still don’t understand.  Or maybe I just don’t want to.  Maybe I just can’t stomach the concept that my life will end before I’m rid of this damn disease.  That it will end before the day arrives when I can finally greet the alarm clock without suspicion and dread. 

The second time I realized what I might be up against was in the inappropriately tilted book by Peter D. Kramer, “Against Depression.”  While in theory, its title might be appropriate, anyone who suffers from depression is likely to feel even more depressed after reading it: 

Depression leads to poor health behaviors, through apathy.” 

Depression was (being) implicated as a risk factor for stroke and heart disease.” 

In old age, depression becomes a straightforward risk for shortened life, not through suicide but through ordinary ill health.” 

You see, my life has already been shortened by this disease.  This past week alone I spent the major portion of each morning in bed, sometimes not rising until noon or later, partially because I was depressed, and partially because of insomnia (brought on by hypomania) that hasn’t allowed me to sleep more than two hours at a time. And then there are all of those moments and days that I wasn’t really present because I was manic and out of control, shopping, gambling, fornicating, doing everything to excess, being extreme, being some alter-ego, but not myself. 

I’ve already lost a third of my life (a pretty safe estimate) to this disease.  Somehow I don’t think it’s fair that it’s a statistical reality that I might also have to forfeit another couple of decades to it on the back end. 

I for one have no intention of going down without a fight.  If my mental handicaps have taught me anything, it’s to be a fighter, to hang on, to hold out for that break in the blackness.  To be patient for that one spring day of walking barefoot in the sand watching the sun set on Stinson beach.  That (sometimes,) is worth all that I have to endure on those other days when my entire life seems buried in fog. 

But I was encouraged by a few things in the Atlantic article, most of them having to do with the mind’s ability to overcome all of the obstacles put in our way, if we can only learn how: 

What we do…affects how we feel just as much as how we feel affects what we do.” 

[The] central question is not how much or how little trouble these men met, but rather precisely how—and to what effect—they responded to that trouble. [The] main interpretive lens has been the psychoanalytic metaphor of “adaptations,” or unconscious responses to pain, conflict, or uncertainty. Formalized by Anna Freud on the basis of her father’s work, adaptations (also called “defense mechanisms”) are unconscious thoughts and behaviors that you could say either shape or distort—depending on whether you approve or disapprove—a person’s reality.” 

Much of what is labeled mental illness…simply reflects our ‘unwise’ deployment of defense mechanisms.” 

AND: 

“…the key to the good life—not rules to follow, nor problems to avoid, but an engaged humility, an earnest acceptance of life’s pains and promises.” 

I have been off prescription medication (for depression/bipolar disorder) for several months now.  Not one day of it has been easy.  Not one day has been spent without some kind of spike, and usually several, up and then down.  But each day was better than a day spent with my moods chemically altered and the associated side effects.  And each day I get to observe my mind for what it is, for how it works.  And each day holds the promise that tomorrow will be better.  That I might live to celebrate my 83rd birthday sipping coffee in a Paris café.

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NYT Sunday MagOf course, none of the drugs work conclusively, and for now we are stuck with what comes down to a refined form of guesswork — 30-odd pills that operate in not completely understood ways on neural pathways, on serotonin, norepinephrine, dopamine and what have you. No one, not even the psychopharmacologists who dispense them after considering the odds, totally comprehends why they work when they work or why they don’t when they don’t. All the while the repercussions and the possible side effects (which include mild trembling on the one end to tardive dyskinesia, a rare condition that causes uncontrollable grimacing, on the other end) are shunted to the side until such time as they can no longer be ignored.”  “A Journey Through Darkness,” By Daphne Merkin / Sunday May 10, 2009 New York Times Magazine. 

Another quiet Sunday on the sofa, a cup of French roast coffee, George Winston on the piano (on the stereo, not in the living room) and the mandatory perusal of the New York Times.  But again, today, as in recent Sundays, my mind is not allowed to drift and contemplate budget tapas in Barcelona or the latest Denis Johnson novel, “Nobody Move.”  No, today I must once again confront the topic of depression.  Seems there is no getting away from it these days. 

The cover story of The New York Times Magazine is “A Long Journey in the Dark: My Life with Chronic Depression,” by Daphne Merkin.

Ms. Merkin’s experience of a hospital stay at the New York Psychiatric Institute, prescription drugs, and the decision of whether or not to try ECT (electro-convulsive therapy) to manage a particularly bad bout of depression, is beautifully told, heartbreaking, and all too familiar. 

The article is worth reading for many reasons.  For one, she covers a lot of ground: therapy, drugs, suicide, and relationships.  For another, while the story may not be a unique one, her ability to use language to make a point or to describe an emotion, is almost painfully beautiful and right on target. 

In some way, the quiet terror of severe depression never entirely passes once you’ve experienced it. It hovers behind the scenes, placated temporarily by medication and renewed energy, waiting to slither back in, unnoticed by others. It sits in the space behind your eyes, making its presence felt even in those moments when other, lighter matters are at the forefront of your mind. It tugs at you, keeping you from ever being fully at ease. Worst of all, it honors no season and respects no calendar; it arrives precisely when it feels like it.” 

My only issue with the essay is the ending.  For a woman who has “…not been free of psychotropic medication for any substantial period since [her] early 20s,” and admits to gobbling down a “…medley of pills — Lamictal, Risperdal, Wellbutrin and Lexapro,” she seems content with the idea that Abilify is the answer, albeit a temporary one. 

While I am always happy that someone has even momentary relief from the pain of depression, I can’t help but have that feeling overshadowed by disappointment at the fact that these stopgap measures are our only, short-lived, salvation. 

How long will we have to play prescription Russian roulette, wasting precious months, even years, as we wait to see what combination will work for us, all the while knowing that the solution is never permanent?  Never a cure.  While Ms. Merkin’s essay tries to end on a positive note, it is at best, a bittersweet one.

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