"Quetiapine comes from the root word 'quiet'"

[UPDATE: I had some funky issues with my table. It should be fixed now. Sorry about that.]

The first time I visited my psychiatrist for my initial evaluation, he gave me the option of choosing one of three medications: Seroquel, Lithium, or Lamictal. He handed me information about Seroquel and Lamictal. I did some research on both meds (lithium was out of the question because I don’t have time to get my blood checked constantly) and Lamictal sounded like a way better deal than Seroquel. I found mental health blog Furious Seasons (probably via The Trouble With Spikol) and read numerous posts on Seroquel’s adverse effects and all the good stuff AstraZeneca doesn’t tell anyone. From Philip Dawdy’s “Seroquel, The Bipolar Pill?” post, here’s what stood out to me:

“He told her that he didn’t think Seroquel worked benignly for patients and that the increased blood-sugar levels and cholesterol levels associated with its use were unacceptable to him. She broke out a recent paper which claimed that there were no metabolic syndrome problems with Seroquel.”

The post got me thinking. One of the materials I received from my psychiatrist was an article on how Seroquel seems to help the depressive part of bipolar disorder. He had a stack of these articles. My guess is not that he’s an overzealous reader of various newspapers but received the glowing article from – you got it! – a pharma rep. The article was taken from the August 2005 issue of Clinical Psychiatry News. (NOTE: I received the article in November 2006.)

Clinical Psychiatry News’ publication goals:

“Clinical Psychiatry News is an independent newspaper that provides the practicing psychiatrist with timely and relevant news and commentary about clinical developments in the field and about the impact of health care policy on the specialty and the physician’s practice.”

Good thing they didn’t say objectively.

I don’t know much about ClinPsych’s reputation and whether they are generally a good paper that reports things objectively. However, the article, “Atypical Quetiapine Appears Effective for Bipolar Depression,” reads like a press release. I’m not happy about receiving (practically) PR material from my doctor when trying to make an unbiased decision.

The article’s lede:

“The atypical antipsychotic quetiapine led to significantly greater reductions in bipolar depression than did placebo within the first week of treatment and throughout an 8-week randomized, controlled study of 511 patients, Andrew J. Cutler, M.D., said.”

Dr. Andrew CutlerDr. Cutler? Who IS Dr. Cutler? No research necessary; look no further than the article itself:

“The differences between the placebo group and each quetiapine group were significant at each weekly assessment, said Dr. Cutler of the University of South Florida, Tampa. He is a speaker and consultant for, and has received research grants from, the company that makes quetiapine: AstraZeneca.”

At least they disclosed his financial affiliations.

It is also worth noting that Dr. Cutler also founded a clinical research company, CORE Research, which runs many of the clinical trials that he’s involved in. CORE Research’s background details:

“CORE Research, Inc. is a private research company with three offices in the Central Florida area. CORE specializes in pharmaceutical research and psychopharmacology for mental illnesses such as Bipolar Disorder, Depression, Anxiety, Schizophrenia, Attention Deficit Disorder, and Insomnia.”

Private + Pharmaceutical research + Psychopharmacology = Funding from Big Pharma Companies

I sound like I’m touting some grand conspiracy theory. (OK, maybe I am.) CORE’s background bio makes the company sound objective and unaffiliated, which isn’t the case. If Dr. Cutler has “received research grants from” not only AstraZeneca, but other companies, it’s in his best interest to make sure that their pharmaceutical products turn out OK. Namely in the interest of AZ – remember: he’s a consultant for them.

How can I expect to make a decision about which medication to take (remember it’s between Lamictal and Seroquel now) based on promotional materials from pharm companies and – oh – an article touting the benefits of Seroquel with quotes only from the study’s lead author who is paid to say good things about the company’s products?

I didn’t.

Then how did I decide on Lamictal over Seroquel? Wikipedia‘s outline of each medication’s side effects, of course, in addition to other materials. (Don’t EVER overlook the Patient Safety Information of any medication. Unless you’re reading about the molecular structure – ignore that.)

Lamictal (lamotrigine) side effects Seroquel (quetiapine) side effects
Headaches Sedation
Insomnia Agitation
Insomnia Constipation
Major weight loss Memory problems (i.e. anterograde amnesia)
Blurred/double vision Headaches
Muscle aches Abnormal liver tests
Lack of coordination Dizziness
Sleepiness Upset stomach
Nausea Substantial weight gain
Vomiting Stuffy nose feeling
Rash (Stevens-Johnson syndrome) [uncommon in adults] Neuroleptic malignant syndrome [rare]
Binds to melanin-containing tissues (i.e. iris of the eye) Tardive dyskinesia [rare]
Diabetes [unclear]
Cataracts [possible]

Not that Lamictal’s side effects looked like a walk in the park, but considering that I’d already had awful trouble with weight gain on Paxil and Lexapro – nearly 50 lbs. – Seroquel was a serious no-go on my part. That and I don’t mind major weight loss from Lamictal. (Although I have been told Lamictal has no effect on weight.) Below is a copy of the article I received from my psychiatrist or you can just go and read the archived full text at Clinical Psychiatry News.

Quetiapine article

My semi-daily fluoxetine update

Okay, the brain shivers are gone. Completely. I still get some vertigo and light-headedness but it happens maybe three times a day max. So fluoxetine has eliminated some of the effects.

I wasn’t prepared for fluoxetine’s side effects, however. And boy, it’s got some kickers.

Since I was on an incredibly low dosage (10-20 mg), there weren’t many side effects.
But boy, is somnolence kicking my butt.

After becoming used to waking up before I’m supposed to, now I’m having the opposite problem: I can’t get up at all. I need my husband to drag me out of bed. And since he’s so nice, he doesn’t do that either.

Argh. As of Friday night, I’ve stopped taking fluoxetine so I’m praying to God that these side effects will go away. I hate somnolence. I’ve had that issue with hydroxyzine (Atarax) and it’s the same reason that I refuse to take quetiapine (Seroquel). I’m getting sleepy right now. If I can get up before noon, I’ll be so freakin’ lucky.

The metabolism aspect of fluoxetine doesn’t make me jump for joy.  According to my favorite “reputable” site, wikipedia:

“Fluoxetine is metabolised to norfluoxetine, and it may take up to 1 to 2 months for the active drug substance to disappear from the body.”

I don’t know if I can tolerate somnolence for 1-2 months. I hope the side effects from this is out of my system by the end of the week.

Come to think of it: somnolence vs. brain shivers?

I’ll take somnolence ANY DAY.

Fluoxetine helps offset Effexor withdrawal

ProzacGreat news: I upped my dosage took 20 mg of fluoxetine last night and the Effexor brain shivers have completely worn off. My cognitive functioning has completely returned and I’m no longer afraid of passing out when walking or turning to talk to someone. I’ll probably take another 20 mg tonight and call it a day for fluoxetine. (Thank you Dr. Ivan!)

So it’s true: If you’re experiencing Effexor withdrawal, ask your doctor or psychiatrist (whomever you’re seeing for mental illness) for 20 mg of fluoxetine and take it for about 2-3 days.  This may not work for everyone (especially those who may be treatment-resistant) but I’m confident it can work for the vast majority of sufferers. I’ll tell you later if I have a suicidal relapse; I’ll be on the alert for the next two weeks. That’s how long it took me to have a relapse when I quit Lexapro cold turkey.

Many thanks to Furious Seasons for the shout-out.

UPDATE: An old post from a blog detailing an Effexor withdrawal experience. I was on Effexor for about 3 months and the withdrawal effects were essentially the same.

Venlafaxine withdrawal symptoms

Work has got me busy, folks, so posts may drop significantly in the next coming days/months. Possibly through April or May. (I’ll probably have one of those work days when I end up doing more blogging than working. It happens every now and then.) But don’t be surprised if Saturday quotes, Wednesday puppies, and Sunday stats are what pops up each week. I’ve got many of those backlogged through April. I’ll try to backlog some other posts on bipolar disorder and depression for the coming weeks and quickly blog on anything that’s timely.

electric shockIn the meantime, I had to take a sick day today. It’s my third day off of the Effexor and I’m having some weird side effects (see Case 1: Standard Dose under the link). Whenever I turn or move too quickly (consider your “natural” body turn), I “kind of” see stars and the whole world slightly spins beyond my field of vision for about 3 seconds before coming back into focus. After doing some light research on the side effects of venlafaxine (Effexor’s generic name), I’ve found out that side effects can incude vertigo, dizziness, light-headedness (associated with dizziness), and something called “brain shivers,” which are a form of electric shock sensations. You know that feeling when you get an electric shock from somebody? Yeah, imagine feeling that throughout your whole body. Precisely; not a good feeling. Nancy Schimelpfening, blogger for depression.about.com, found a newsgroup posting on the brain shiver effect, mainly associated with venlafaxine:

It happens to me if I turn my head quickly, or if I stop suddenly, or in general with sudden motion. They’re worse if I’m nervous.

i’ve seen them described as feeling as though your brain keeps going when you turn your head. that doesn’t seem quite adequate to me. it’s more like this:

you turn your head (or your whole body — this happens to me if i whirl around too quickly as i’m taking the stairs. what. doesn’t everyone whirl on the stairs…?), but your brain *stays put* for a micro second, then tries to catch up but only in a stuttering, stopstart motion, accompanied by a staccato ‘zzt zzt zzt’ with each stop. the ‘zzt’ you can feel in your head, an electric sort of vertigo, and it often reverberates in your hands and fingers. some folks feel it in their toes; i haven’t yet.

sometimes your brain overshoots and comes strobing back, then overshoots again.. this all unfolds in just a second or two.

these days i endeavor to go around corners all smooth slow and steadylike. helps to reduce the number of brain shivers per day

Yeah, that’s me. It’s hard to explain to someone who’s never felt it. I got this feeling after not taking Paxil for three days too. The effects eventually wore off, but it was such a weird feeling.

Continue reading “Venlafaxine withdrawal symptoms”

Paxil withdrawal

paxilThanks to Philip Dawdy at Furious Seasons, he wrote about the Uncomfortably Numb blog. The blog focuses mainly on the side effects (and side effect withdrawals) of Paxil. Having been on Paxil (CR), I can identify. I was fortunate enough to ask my doctor for a switch after three months, but I still have this occasional eye-twitch that lasts for days that has stayed with me since taking Paxil back in February 2004. If I didn’t take Paxil for three days, my nerves just went horrible: I felt shaky and my entire life seemed fluid – it was like constantly walking in a pool of water. Nothing seemed real; everything was a dream. But it wasn’t. Everything was too hard, too much effort, too much anything. I couldn’t stand it. I quit Paxil “cold turkey” (again, don’t do this, kids) and felt worse before I could feel better. I went from Paxil to Lexapro and… yeah, felt worse again.

Lesson? Primary care physicians should NOT give antidepressants to depressed people with undiagnosed bipolar disorder.

Just another day

Originally written October 16, 2006 (Updated edits in bold red)

“So sad / so sad / sometimes she feels so sad” ~ Paul McCartney, “Another Day”

I’m finishing up my third full day in the psych hospital and I’m accomplishing things totally unrelated to my “treatment.”

I’ve gotten through 100 pages of Mark Twain’s The Adventures of Tom Sawyer. It’s an interesting book — never read it before – and reading about Tom’s mischevous ways takes me away from the dreariness of a psych hospital. I have a mind to read Huck Finn afterward.

Your Drug May Be Your ProblemI’m reading several books at once, however. (I’ve got ADD when it comes to books; sometimes I finish them, sometimes I don’t.) I’m finally reading my Bible again and trying to plow through Your Drug May Be Your Problem. It’s an interesting book but most of it is alarming. The authors, Breggin and Cohen, argue against psychiatric drugs completely. The books raises some awareness about the use of psychiatric drugs but I think the authors are mostly crying “Fire!” about an unattended candle. The only time I somewhat took them seriously was their discussion about lithium. I’ve already heard — and now seen — its effects. I think lithium is a drug that really shouldn’t be used any more. Are the therapeutic effects of lithium really worth risking a patient to possible toxic levels?

Continue reading “Just another day”