Dr. Grohol interviewed Dr. Phil Ninan, Wyeth’s VP of Medical Affairs on Pristiq, its efficacy, and surrounding issues. It was quite an interesting interview (and long) but here are some highlights that I chose to comment on. I’ll be making some comments in between Dr. Ninan’s answers due to the extensive length. Some parts of the answers have been truncated.
Posting may be light through Friday as I’m proofing an ENTIRE website — medication-related, actually — and making all the web copy is correct, the links work, and that the design/layout isn’t funky. Since it’s a website, it’s a huge job and it may take me until Friday. Here’s an example (not the real site I’m working on) of the monstrosity of the kind of work I’m doing. I’m proofing every single piece of text on every page. Funny thing is, I don’t mind. I love what I do.
I have my psychiatrist appointment at 3:30 pm so I might be able to get a quick post in to let you know what happens. He’ll probably be concerned that I didn’t take my Abilify, but I just stopped taking fexofenadine (Allegra’s generic equivalent) and have begun to drop weight. I don’t need Abilify to help me pack it back on it again. I can do it quite easily with the help of the amazing bakery across the street.
I had counseling last night but will be going again next week. I usually go once every two weeks, but my counselor is concerned since I’m having a consistent reoccurrence of suicidal thoughts. Even when I’m in a good mood, I still think of finding a way to kill myself. That’s not depression so much as it is my negative way of thinking. However, it’s still cause for concern considering that dwelling on the idea could actually lead to another attempt.
I’ve read a few blogs in which people are enduring Risperdal withdrawal. I have a friend who’s currently coming off of Risperdal because her blood sugar is so high. She’s been on it for years. That’s one of the reasons why I don’t want to take an antipsychotic. Doctors put patients on it for long-term maintenance when most of the clinical trials have only studied short-term effects.
I’ve become dissatisfied with how narrow the layout is on my blog so it’s possible that if you visit the site, it’ll look funky every now and then as I play around with it and decide on one I like. I’m not an expert with CSS so I tinker with it until I’m satisfied. I’d like my text area wide enough to post YouTube videos and pictures without them getting cut off. Just letting you know so you don’t wonder what happened to your browser.
Last but not least, if you like this blog, then please go to this one and donate $1, $2, or $5. If you know me in person, please donate as well. (I made a plea about this last week.) That blog provides me with inspiration to keep on going. You can donate to Philip Dawdy via PayPal, check, or money order. (I guess you could send cash too but that’s never recommended.) Philip’s blog, Furious Seasons, has helped many people in the mental health community including myself.
Gianna at Psychiatric Drug Withdrawal and Recovery has written a post about reconnecting with her spirituality and working with her doctor on more med tapering. Toward the end, she wrote:
I went for a walk the other day with a woman who could’ve been my client from years ago when I worked with the “severe and persistent mentally ill.” She was so sweet and warm—yet there was a deadness in her that I recognized as familiar from the clients I worked with on heavy neuroleptics. I was so glad to walk with her as an equal and not as a social worker—she is my peer and we talked to each other as such. She is getting tardive dykinesia from her neuroleptic. I asked her how long she’s been on it and it’s been 2 decades. I asked how long she has been stable and she said 12 years. I wanted to scream. This poor woman is half dead inside for no good reason. She is on three medications for bipolar disorder and has had no symptoms in 12 years. I see that as criminal, especially since it’s clear a part of her is dead, just as I’ve been dead for many years but am now coming back to life.
I gently talked to her about talking to her doctor. “If you’ve been symptom free for 12 years maybe you don’t have to be on a toxic drug that is giving you tardive dyskinesia,” I suggested. I didn’t add she struck me as part dead too. I want to help all of us who are being over-medicated and poisoned. How can I do that? This blog is simply not enough.
In response, I wrote this comment on her blog:
I was taking effexor for about 4 months due to having a anxiaty attack one day.
One day I just felt like I was ready to get off of them.
I started by slowly bringing down my dosage. Did that for 2 weeks. The 3rd week I stopped taking them all together.
The worst sympton I felt was the dizzy feeling, I think they call it vertigo. That lasted for up to 2 weeks after stopping the medication.
I am proud to say I am now completly effexer free, with no side affects any longer. It can be done. Just go slow !
~ Sarah McLachlan, “Drifting”
I have an appointment with my psychiatrist on Tuesday morning. I’m not quite sure what to do.
My “symptoms” are back. Now that I know what to look for as someone with bipolar disorder, I am aware of them. I’m having mania moments. I don’t want to sleep. I have no desire to. My husband sometimes MAKES me go to sleep. I’d rather be up doing the laundry, washing the dishes, blogging, reading other blogs, making to-do lists, and organizing the apartment–all at the same time–at 2 or 3 am. (This doesn’t mean all of this stuff gets finished.)
My husband and I have had physical fights in the past where he has had to restrain me because I wouldn’t go to bed and I wouldn’t sleep. It would be 4 in the morning and I refused to sleep and I’d fight him tooth and nail. I don’t know why. I have no problem wanting to sleep at 2 pm. Make it 2 am and there’s too much to do suddenly. I have the superhuman ability to get things accomplished between midnight and 5 am more than I can during the hours of 9 am to 11 pm. Right.
So now it’s almost 1 in the morning and I have nursery duty at church later in the morning. Then I have a hair appointment in the afternoon. Then I’m paranoid about what my hair stylist thinks of me.
She says she’s my friend but I wonder if she’s just pretending to like me because she feels sorry for me. I’m really lame you know. People at work acted nice to my face and then dissed me behind my back. She does the same thing to others, why wouldn’t she do the same to me? She just keeps me around and kisses up to me because I tip well.
Thinking like that scares me. It reminds me of the way my father used to think. Paranoid. (You can stop reading here. At this point on, it’s just a manic ramble that’s basically full of nothing but stream-of-consciousness just because i can.)
Mental Health Blogs Going Bye-Bye?
As I noted earlier, there’s a spate of mental health blogs that are going on hiatus of some kind. Now, it’s my sad duty to report that Gianna Kali’s Bipolar Blast blog is going on an indefinite hiatus as well. You can read her post "Quitting?" for the details. Bottom line: all those years of very high doses of psych meds seem to have injured her body. I cannot even begin to send her enough good wishes. I cannot even begin to express my disgust with some of the bad doctors she ran into over the years.
Also, the Psych Survivor blog, written by a man I only know as Mark, was taken down a few weeks ago, and from what I gather he is in the hospital with heart problems. His was/is a good and strident voice on these issues we all care about and his work is missed.
All of this kind of makes me feel glum, since the two people above had been at the blogging game for well over a year and I sensed that they’d both be around long-term. These are people I care about and it sucks that they won’t be the presence they once were.
Why is it that mental health blogs are so difficult to do and keep going? Why is it so hard for them to find the substantial audiences they deserve? The Internet is crowded with blogs about politics, technology, gadgets, gossip and parenting and many of these seem to do quite well and have huge audiences and long lives, despite the fact that many of them are merely echoes of one another. Are readers of blogs that simple-minded that all they need is the latest news and opinion on Apple’s or Microsoft’s latest bit of software or Obama’s or Hillary’s latest gaffe?
You’d think in a country where 10 percent of the population is on anti-depressants and another 5 percent to 10 percent is likely on some other psych med that there would be a substantial audience for these issues (regardless of what one makes of the dominant mental health paradigm), especially given how wildly popular neuroscience is on the Net. It makes me wonder if we all–and here I include myself–have done something wrong in how we analyze these issues (are we too contrarian?) or if we all simply haven’t been crowded out of the big search engines (that’s how most people find mental health information online) because the Net is so over-populated with pharma sites and allied pro-pharma health websites. I can certainly say that the mainstream media–which usually loves writing about characters on the Net who push against life’s many intellectual tides–has given very little attention to sites like this one, despite the fact that sites like mine have been a very real service to many in the media.
Or maybe the mainstream approach to mental health care is right and the public is just trying to tell us something.
What do you think?
I’ll tell you what I think.
Dawdy at Furious Seasons wrote a post on an editorial in the LA Times by Summer Beretsky’s experience with Paxil. After reading her editorial, I’m reminded that my own experience with one antidepressant wasn’t all that unique. Her drug was Paxil for panic attacks; mine was Lexapro for depression following a 3-month (on-and-off) stint with Paxil. I’m struck by the similarity of our experiences; not only did the same thing happened to me but I was also a communications major in college as well.
Paxil had one pretty undesirable effect on me: I started to lose interest in just about everything. I stopped initiating social activities (who needs that sort of thing?) and was no longer motivated to perform well academically.
My emotions had flat-lined: I hadn’t cried in months, nor had I proverbially jumped for joy. I felt — nothing.
I can still remember sleeping in bed at home on a weekday when I should have been at class. It was 2 in the afternoon, around the time my copy editing class was to begin. My boyfriend at the time (now my husband) lived in Kentucky while I attended college in New York. He planned to visit me that weekend but was getting fed up with my depression and listlessness. He called from work to tell me to get up and go to class. I mumbled on the phone, half-confused, and said no. He demanded, “Why not?” I said quite plainly, “Because I don’t care.” He said, “If you don’t get up and go to class, I won’t visit you this weekend.”
I replied, “I don’t care.”
I’m catching up on reading my fellow bloggers’ posts (see Blogroll to the right), so if you’re not reading their site already, I’d encourage you to do so. Below are some posts that caught my attention. Some might be a little dated.
Gianna at Bipolar Blast: Has a video up of Gwen Olsen, an ex-pharma rep who says that pharmaceutical companies aren’t in the business of curing but in the business of "disease maintenance and symptom management." It’s nothing new but here are two quotes that caught my attention:
"And what I’m saying is provable is that the pharmaceutical industry doesn’t want to cure people. You need to understand specifically when we’re talking about psychiatric drugs in particular that these are drugs that encourage people to remain customers of the pharmaceutical industry. In fact, you will be told if you’re given a drug such as an anxiolytic, or an antidepressant, or an antipsychotic drug, that you may be on the drug for the rest of your life. And very frequently, people find that they are on the drug for a very long period of time, if not permanently, because they’re almost impossible to get off of. Some of them can have very serious withdrawal symptoms – most of them can have extremely serious withdrawal symptoms if they’re stopped cold turkey – but some people experience even withdrawal symptoms when they try to titrate or they try to eliminate the drug little by little, day after day."
"We have got to start making the pharmaceutical industry accountable for their actions and for the defective products they’re putting on the market. It won’t be long before every American is affected by this disaster and we need to be aware of what the differences are between diseases between disorders and between syndromes. Because if it doesn’t have to be scientifically proven, if there are no tests, if there are no blood tests, CAT scans, urine tests, MRIs – if there is nothing to document that you have disease, then you in fact, do not have a disease, you have a disorder and it has been given and has been diagnosed pretentiously and you need to get yourself educated and understand that there are options and those options are much more effective than drugs."
I’ve always wondered why doctors don’t run tests to diagnose any psychiatric disorders. From NIMH:
Research indicates that depressive illnesses are disorders of the brain. Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression. The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally. In addition, important neurotransmitters–chemicals that brain cells use to communicate–appear to be out of balance. But these images do not reveal why the depression has occurred.
If MRIs have shown that the people with depression have a part of the brain that functions abnormally then why isn’t it standard for all people diagnosed with depression to have an MRI done to confirm this? I have one of two hypotheses: it’s too expensive to get an MRI done for each person and that insurance won’t pay for it or the abnormal functioning cannot be detected in the brain of every depressed person. Therefore, is major depressive disorder really a made-up diagnosis?
Gianna, a reader of this site, has a great and informative blog, Bipolar Blast. In a recent post, she gives some tips for proper psych drug withdrawal. This is particularly helpful for those dealing with severe antidepressant withdrawal effects. For me, Effexor comes to mind. I also think about "Honey’s" experience with Zoloft. Not only does Gianna emphasize diet and nutrition as an important part of the process, but she also delves into proper titration. (Many people think that the diet and nutrition thing is obvious, but many people overlook that important piece of recovery.)
I understand that many people – especially in the psych world – think Peter Breggin’s a wack job, but he can have some good points. Gianna refers to Breggin’s 10% rule:
"Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. It should be noted that some medications should not be dissolved. Especially time released medications. This would be extremely dangerous."
Gianna clearly knows what she’s talking about. Head on over to her site to read the rest of the post.
I really should have posted on this a LONG time ago, but Graham’s Blog has done an unbelievable job of tracking his Effexor withdrawal symptoms. Something I learned today:
"| Night Sweats – I had this very bad, constantly wake up drenched in sweat,
literally soaked to the skin and to the mattress. But Have just realised I have
not had these severity of symptoms for some weeks, which is helping with the
consistency of sleep."
Ohh, so that’s why I wake up drenched in sweat in the middle of the night regardless of whether it’s warm or cold in my room. To quote Dawdy over at Furious Seasons, like Paxil, it truly is the "gift that keeps on giving." Hooray for long-lasting effects from psych meds! [sarcasm] Now, I’ve got this occasional twitch in my cheek. I took Paxil for about 3 months in 2003 and I still get eye twitches that I never had previous to the medication.