Generic Lamictal (lamotrigine)

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.

What the heck has happened to me?

Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

  • racing thoughts
  • spending sprees when I have no money
  • cleaning at odd hours of the night
  • thinking that I’m the most amazing job interviewer ever
  • worrying that people are watching me through video cameras or the wall in public bathroom stalls
  • afraid that a video camera exists in our bedroom (I know it doesn’t. I think?)
  • talking to "friends" who don’t really exist
  • disobeyed parents
  • talked back to authority
  • suicide attempts
  • rage/anger/hostility/irritability
  • temper tantrums
  • violent outbursts
  • socially awkward
  • extreme mood swings (happy to sad or angry in the same day)
  • doing things and barely remembering them
  • memory loss/forgetfulness
  • chronic fatigue
  • indecisiveness
  • no interest in sleep
  • inability to focus on one thing for an extended period of time/lack of concentration
  • anxious about being around people I don’t know/don’t like
  • anxious to go out and spend time with friends and/or family
  • impulsiveness
  • overeating
  • persistent, negative thoughts

All right. So those are some things that have occurred over the course of my life. Let’s see what I diagnoses I can pigeonhole myself into.

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Pregnancy is NOT a mental illness

I stumbled upon Yankee Cowgirl’s blog that mentioned Congress is working on the MOTHERS (Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression) Act which would “strongly encourage pregnant women into mental health programs – that means drugs – to combat even mild depression during or after giving birth.”

She links to a column written by Byron J. Richards on newswithviews.com. He writes:

The Mothers Act is pending legislation that will indoctrinate hundreds of thousands of mothers into taking dangerous psych drugs.

He goes on to slam Big Pharma about how they control Congress and how mothers don’t need psych drugs for a natural birth process.

The Mothers Act (S. 1375: Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act) has the net affect of reclassifying the natural process of pregnancy and birth as a mental disorder that requires the use of unproven and extremely dangerous psychotropic medications (which can also easily harm the child).

These are some serious accusations. I got pretty riled up myself and decided to see what Congress said in the bill.

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Women & Antidepressants

Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”

Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)

The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.

“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”

Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.

“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.

A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”

I’m sure the list goes on, but magazines have but oh so much space.

Melissa McNeilDr. Melissa McNeil at the University of Pittsburgh points out three things:

  1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
  2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
  3. Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.

My take on McNeil’s points (I’ll try to keep them brief):

  • Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
  • Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
  • Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.

Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.

Viktor BouquetteDr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:

“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”

Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.

McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.

“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”

Oh, for more doctors like Haltzman and Bouquette.

UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.

Hypochondriacitis?

“You’re not a hypochondriac if you’re trying to convince yourself that you’re a hypochondriac.”

For the past month, I’ve been feeling fatigued, shaky, dizzy and have had bouts of vertigo. I’ve been going home after work, then crashing into bed for the rest of the night. I went to the doctor and she said nothing’s wrong except that my physical symptoms are being caused by depression. I’m not depressed at the moment and I’ve never had vertigo when I was in my severest depression so I think that’s a load of crap. However, I had a blood test that also checked my Lamictal levels and everything came back A-OK with an unusually high cholesterol level for a 25-year-old. (High cholesterol runs in my family so I’m at higher risk for heart disease, blah blah blah.) Despite the fact that science says I’m currently healthy, the way I feel says I’m not.

Anyway, I saw the Q&A below from the May 2007 issue of Shape magazine and related to it somewhat. I’m still not quite sure that my physical symptoms are manifesting through my depression when I haven’t been depressed for the past month.

“I’ve been tired and spacey lately and also started experiencing chronic headaches. My doctor says nothing’s wrong. Is it all in my head?”

No, there may be more going on than you or your doctor realizes. Headaches aren’t just caused by physical problems; they may also be a sign of depression. A new study at the University of Toledo found that women with chronic headaches, especially migraines, are 25 times more likely than other women to report symptoms of clinical depression. (emphasis not mine) Some other common signs include being unable to concentrate, gaining or losing weight suddenly, difficulty sleeping, or feeling fatigued, or losing interest in the things you usually love to do. But these symptoms may be overlooked during a medical 4evaluation, especially since many women don’t realize they should bring them up with their doctors. Twice as many women as men suffer from depression, yet nearly half of all cases go undiagnosed. If this sounds like you, make a doctor’s appointment to discuss any stressors in your life and their effects on your health.

Gina CuylerGina Cuyler, M.D., FACP, is a board-certified internist, instructor of clinical medicine at the University of Rochester Medical Center, and a fellow of the American College of Physicians.

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.

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