I underwent my second ketamine infusion on Monday and listened to 90s alt rock. That…was different. I have discovered that recreational drugs would not be a thing for me. Thank goodness this is all under a controlled environment and I’m being monitored by a nurse and a doctor.
On Tuesday, I ended up being grumpy and irritable again. I can’t say for certain whether I was irritable due to the treatment or my kids just being assholes. I suspect it was a combination of both. Regardless, I felt okay on Wednesday.
I underwent my third infusion Wednesday afternoon and I feel okay still. It’s Wednesday evening and my brain is firing on all cylinders, I’m not sleepy, but I am very “out of it.” I don’t feel “all here.” I know sleep will help rectify it but it will be interesting to discover whether I am irritable again tomorrow (a snowstorm that will keep my kid home is likely to do it) or if my mood is somewhat better. My mood rating according to my rating scale is a 7. My guess is that my doctor would like me to shoot for a 9 by my last infusion (happy) but I’m content to just be “okay.” I’m always “here.” I’m never doing great or feeling fantastic unless I’m manic. Is it possible to get the euphoria of mania without the downside of the crash? It would be nice to know. Although I do have more energy and motivation for things than I did before the infusions.
Most importantly, my baseline is whether I’m dealing with suicidal thoughts. I did suffer from a little depression 2 days after my first infusion but since then, I’ve been okay. Before my first infusion, I took the PHQ-9, and I scored a 17. Today, before my third infusion, I scored a 6. I’m not sure what the hell happened but I’ll take it.
I think my pain points will be trouble falling asleep and staying asleep and overeating. I’ve been having difficulty concentrating lately so that might also be a factor that may keep my PHQ-9 from dropping much more. And I’m also super restless. Like I have too much energy that I need to burn off. I’ll use my son’s words: “fizzy feet.”
The FDA has approved a nasal spray called Spravato to treat suicidal patients. The drug was approved for those with treatment-resistant depression last year, but has also shown promise to reduce symptoms in suicidal patients in conjunction with therapy and other antidepressants. The drug, while FDA approved, is only administered by a health care provider and is not approved for home use.
A cursory search on Google for Abilify + Prozac didn’t yield too many helpful results. I suppose it’s not a common drug combination. So far, I haven’t had any real side effects. I take Prozac in the morning and Abilify at night. I’ve also started taking my vitamins again after shirking them for quite a while: Fish Oil with Omega-3s, Iron (for slight anemia), Vitamin B-Complex with Vitamin C, and a women’s multivitamin.
I am a little nervous about taking an SSRI again because the last SSRI I was on (Effexor/venlafaxine) produced some nasty side effects (mania, night sweats, vivid dreams, brain shivers) along with the one I liked (significant weight loss). When I last blogged about Prozac, my only side effect was somnolence—a side effect I don’t appear to be experiencing this time around.
Are you on a drug combination? If so, what and is it working for you? If you used to be on a drug combination, what was it and did it help?
I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.
I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.
My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.
I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.
"Orexigen, in creating its obesity drug Contrave, took a treatment used for drug and alcohol addiction and combined it with an antidepressant sometimes used to help people quit smoking." (My guess is that the antid was Zyban.)
It's a nice concept, but I'd hate to see risk of side effects doubled. One med can be a doozy; coupled with another could turn out to be problematic.
"For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved."
Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.
Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.
The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.
Doesn't the last sentence make you feel all warm and fuzzy inside? It's great to know that getting people to use drugs are more important to these companies than making sure these drugs are safe to use. Yeah, yeah, I know, it's a company and companies are only out to make profits. Whatever kind of optimist is in me wants to believe that maybe there's one doctor out there who is more motivated by helping others than by pharma-backing money. But I'm only a slight optimist.
“An article on brain shocks from about.com linked to a statement at socialaudit.org.uk on venlafaxine withdrawal. It seems that when coming off of venlafaxine, it is best to use fluoxetine (Prozac) in conjunction with it. Somehow, Prozac’s effects can minimize or negate the side effects of Effexor allowing for an uneventful withdrawal. I’m seeing my psychiatrist later today and I might bring up the idea with him. He might think one of two things: a) I’m crazy (pun not intended) or b) I don’t know what I’m talking about. My guess is he’ll choose the latter of the two.
Unlike most patients, I know more about meds than ‘the average bear.’”
UPDATE: I asked my doctor about going on fluoxetine to offset the effect of venlafaxine withdrawal. He looked up, somewhat shocked, and said, “Yeah.” So then I pushed and said, “Well, I’d like 10 mg then.” lol. He wrote out a prescription for 10 mg of Prozac in addition to bumping me up from 150 mg to 200 mg of Lamictal. I took the fluoxetine (Prozac is now a generic drug) last night and it has offset the intensity of the brain shocks. I experience them but they are much more mild compared to yesterday when they were moderate to severe. Yesterday, I was barely able to drive; today, I drove nearly an hour to work on a somewhat urban road with good reflexes and almost normal cognitive functioning. I can only hope that the Prozac continues to aid my withdrawal issues. And I was happy to wake up this morning without wondering why I dreamt that I was in a department store with parrots singing Gwen Stefani’s “Wind It Up” and swinging like moneys instead of flying.
You get the idea: Effexor causes some strange dreams.
“Suicidal patients taking antidepressants have a ‘markedly increased’ risk of additional suicide attempts but a "markedly decreased" risk of dying from suicide, a large Finnish study has found. “The research into nearly 15,400 patients hospitalized for suicide attempts between 1997 and 2003 showed that ‘current antidepressant use was associated with a 39 percent increase in risk of attempted suicide, but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause,’ the authors wrote in a report published in the Dec. 4 issue of Archives of General Psychiatry. “The Finnish study analyzed 15,390 suicidal patients of all ages for an average of 3.4 years. The authors said they did this ‘because previous suicide attempts are the most important risk factor for predicting suicide.’”
I think 15,390 patients is a sizeable, significant study that could probably yield semi-accurate statistics.
“Among the 7,466 males and 7,924 females examined, there were 602 suicides, 7,136 suicide attempts requiring hospitalization and 1,583 deaths recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants. “But the picture was not so bright for all those who took SSRIs. It was for those taking fluoxetine (Prozac), who had a 48 percent lower risk of suicide than those not taking medication. But the study found that those taking another SSRI, venlafaxine hydrochloride (Effexor XR), had a 61 percent increased risk.”
So Prozac is better than Effexor XR in terms of suicidal risk. Nice, considering that I've had a 10-year history of suicidal attempts and this study seems to show that venlafaxine increases the risk of suicide attempts. Perhaps Effexor should be prescribed to those who aren't/have never been suicidal?
The NYT video on health includes a story about how health programs are aimed at baby boomers who are intent on staving off age-related problems such as dementia. (Related to Zyprexa being used off-label for dementia and all…)
ADDENDUM:Eli Lilly wins Round 1 in court. According to the NYT, a federal appeals court has ruled in favor of Lilly in a challenge to its patent on Zyprexa. Ivax (affiliated with Teva Pharmaceutical Industries) and Dr. Reddy’s Laboratories filed a suit saying that a lower court ruling in Lilly’s favor was wrong. Lilly’s patent on Zyprexa expires in 2011. And random Zyprexa data because Seroquel actually looks better in this instance:
“Sales of Zyprexa dropped 16 percent and fell behind AstraZeneca’s Seroquel as America’s best-selling antipsychotic in 2005, according to IMS Health, which provides data on drug sales.”
Originally written October 16, 2006(Updated edits in bold red)
On the heels of discussing my cynicism about pharmaceutics and pharmaceutical companies (namely, psychiatric-related), I have a few questions regarding the approach of psychiatric evalutations:
1. Why aren’t people tested for biochemical imbalances?
2. Is there a way to determine from blood work or an MRI what kind of mental illness a person is suffering from (in conjunction with the patient’s psychiatric assessment)?
3. How do doctors know the appropriate dosage for a patient? Does s/he start a patient off on what is considered “normal” for an average person and then increase or reduce the dosage based on reactions and side effects?
4. How does a doctor know when to increase a dosage? (Figuring out when to reduce a dosage SHOULD be much easier.)
Psychiatry is an inexact science. For the most part, I think much of it — regarding medication, Freud, and now, the pharmaceutical industry — is a crock.