PCPs Don't Know Jack From Zyprexa

Eli Lilly’s actions continue to be appalling.

Apart from trying to hide the fact that Zyprexa induces weight gain, diabetes, and hyperglycemia, they also had sales reps encourage primary care physicians to prescribe Zyprexa for patients who did not have schizophrenia or bipolar disorder (basically off-label usage).

It seems that Lilly told marketing reps to suggest Zyprexa for dementia in the elderly. Lilly denies this, of course, since olanzapine (Zyprexa’s generic name) is not approved for that kind of use since it increases the risk of death in seniors with psychosis associated with dementia. Lilly also attempted to market olanzapine to patients with mild bipolar disorder who suffer mainly from depression. (In actuality, Zyprexa is approved to treat those who suffer from mania.)

This issue with Eli Lilly delves into precisely why I am against PCPs prescribing psychiatric medicines. Primary care physicians don’t know enough about the various psychiatric conditions to prescribe the appropriate kind of medication. This type of prescription should be left to specialists like psychiatrists. PCPs should focus on the things they deal with on a daily basis that no one else can take care of: the common cold, the flu, annual physical, etc. It should be the job of the PCP to refer a patient to a psychiatrist should they present symptoms of mental illness (depression, schizophrenia, etc.). I have been burned by having a PCP prescribe antidepressants for me and as a result, attributed my horrible experience with drugs to that.

My PCP prescribed Paxil for me at first — samples given by a drug rep, of course — but when I developed shaky nerves, she switched me to Lexapro. On Lexapro, I encountered the worst depression of my life: I couldn’t get out of bed for two and a half months and no one could convince me that life was worth living. I had no motivation, no interest in anything, no desire to do anything; my will to go on was essential dead.

Somehow I trudged through that and by January, I was meeting the minimum of my commitments: I interned for Sen. Clinton, saw my psychologist once a week, and attended school as much as I could. My efforts were slow and half-hearted and the outstanding student that I’d been during the first three years of college immediately dropped to average status — “B” or “C.” (Not saying “B” isn’t good but it was out of consistency with my normal “A’s”.)

I got to a point where suicidal thoughts began to plague me in July, a month before my wedding, and finally I decided to quit Lexapro cold turkey. (I’ve since learned this is not a smart thing to do.) Two weeks later, I suffered a relapse and had people talking me out of suicide to the point where the police were called to my place of employment. Afterward, I swore off psychiatric medication and decided that if it worked for others, then it was fine, but it didn’t work for me.

Fast-forward to my most recent relapse where I was in the hospital. The doctor who took care of my intake when I was first admitted prescribed Celexa for me to take the first few days I was there before I saw my “normal” doctor. I skipped my medication, figuring that this doctor didn’t know enough about me to accurately assess whether I needed to be on Celexa versus something else. By the time I saw my “normal” doctor, he briefly went through my history and decided to try me on Effexor XR. I was reluctant but willing. His goal was to get me from 37.5 mg to 150 mg. 150 mg seemed a little high for me, especially since I’d had such a bad experience on 20 mg of Lexapro but he explained to me that 150 mg is as powerful as a low dosage of Lexapro. I wasn’t convinced but reluctantly agreed to take Effexor.

I left the hospital at 75 mg and started to feel good effects. The suicidal thoughts, for the most part, were gone and I felt like I could deal with life for once. I was admitted to intensive outpatient day therapy and remained there for 9 days. I saw another psychiatrist there who decided to finally up me to 150 mg on the Effexor. I agreed to give it a try since 75 mg had been working very well and I’d experienced very little side effects.

Once I jumped up to 150 mg, however, I encountered restless sleep, which I didn’t associate with the Effexor. Once I was released from the day program, I figured out that my restless sleep was tied to the Effexor. Another side effect arose that I didn’t associate with the medication: I began experiencing allergic reactions to it. My hand swelled up to an incredible size so that it was red and I could hold a block of ice without feeling it melting in my hand. Ice packs would turn warm without me putting it down for a single moment. Over time, I experience red patches on my body and little tiny red bumps, similar to mini-hives. I finally saw my recommended outpatient psychiatrist a week later and he told me and my husband that I’d been misdiagnosed and I was a classic bipolar case. He said I’d eventually taper off the Effexor and gave me the option of going on Lamictal, lithium, or Seroquel.

After doing some research and investigating, my husband and I agreed to try the Lamictal — especially since weight gain and morning drowsiness from the Seroquel concerned me. (I gained 50-60 lbs. on Paxil and Lexapro and Effexor helped take an additional 15-20 lbs. off after dieting.) The psychiatrist has put me on a Lamictal starter pack (courtesy of a sales rep) and I’m now tapering off the Lamictal after noticing that the sleeplessness and rashes were related to the Effexor and NOT the Lamictal. (I haven’t had any horrible rashes on the Lamictal so far.) I’m currently on 50 mg of Lamictal and 75 mg of Effexor. The goal is to get me up to 100 mg on the Lamictal and taper off the Effexor. My only concern with the Lamictal is that it’s anti-convulsant and should I ever taper off too fast, I’d experience seizures which I’ve never had in my life.

However, my psychiatrist prescribed the Seroquel IN ADDITION TO the Lamictal and Effexor and I just felt like adding Seroquel would be medication overload for me. So I’m in the process of seeking out a second opinion to find out a) whether I really am bipolar or just suffer from depression and b) if I’m on the right medication. If my second opinion diagnoses me as depression and NOT bipolar, I’ll probably ask him about why the Lamictal is helping me versus other antidepressants I’ve used. Considering my mood fluctuations and everything I’ve experienced in my life, the Lamictal has been the best medication that I’ve ever been on. Maybe it’s possible that mood stabilizers can help those with depression.

So I say all of the above to get to this: If a PCP prescribes a psych med, please, please, please GO see a psychiatrist instead of taking the medication. PCPs know very little about psych meds and don’t keep up to date on all the latest information but are only sold on what drug reps tell them. It’s a drug reps job to sell their product, but it’s a patient’s job to make sure their mind doesn’t get fucked.