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Geodon vs Risperdol vs Lithium October 31, 2010

Posted by Crazy Mermaid in Medication, mental illness.
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I can’t believe it! I just spent $589 for a one month supply of 80 mg of Geodon at  Fred Meyer Pharmacy, a nearby retail pharmacy. This same medication at Medco, an online pharmacy, is $233 for a one month supply. Still, that’s a lot of money. But we don’t yet know whether it’s going to work, so there’s no point in ordering a three month supply at this point. In the meantime,  I’m stuck paying $589 for a one month supply until we know for sure that it’s going to work. And it takes at least 3 weeks before we will know.

When I was in the mental hospital, they started me on lithium, which costs about $15 a month, to control and hopefully eliminate my delusions and hallucinations. But although Lithium is a powerful antipsychotic that almost always works, it has its own share of severe side effects, including a loss of coordination, tremors, restlessness, slowed intellectual functioning and weight gain. But the reason they use it in the mental hospital is because it almost always works for everyone in a severely psychotic stage, bringing them out of the psychosis sooner than any other drug.

In the hospital, I was on 900 mg of lithium, which is a large dose meant to snap me out of my psychosis as soon as possible.  In the controlled atmosphere of the mental hospital, the staff was able to closely monitor the drug, doing blood draws on me every few days just to make sure that I was on the proper amount. They can tell how much your body is metabolizing based on the blood draw information.  They don’t want too much of it in your bloodstream because the side effects get more severe, but not enough means you’re not getting better.

When I got out of the hospital, my first appointment with my new psychiatrist, Dr. K, was the day after my release.  When he examined my records and learned that I was on 900 mg of lithium, he continued me on the lithium, but lowered that dose to 600 mg.  I stayed on the lithium for several months, putting up with those terrible side effects. He promised me at that time that he would only have me on that high of a dose of lithium for a few months, which seemed like forever while I was in the middle of the treatment. Initially, I had to see Dr. K once a week, but that changed to every two weeks after about a month. During this time, he continued my blood draws, making sure that I was getting the proper dose.

After about 4 months, Dr. K said that I was stabilized enough to consider putting me on 80 mg of Geodon, a drug which had fewer side effects.  He explained that for most people, Geodon didn’t cause weight gain, and didn’t have the restlessness  or coordination problems that were the hallmark of Lithium.

Because the Geodon took several weeks to build up to the most effective dose, he continued me on Lithium, gradually reducing that dosage as the Geodon built up. Eventually, after several weeks, he began to taper off my lithium, finally eliminating it entirely over the course of several months.

However, while he was in the process of eliminating the Lithum, I had what I call a few “breakthrough” voices, which means that I heard voices. When this happened, he increased my lithium levels,  attributing the voices to the fact that the Geodon wasn’t yet at its effective dose. For several months, I roller-coasted through several episodes of increasing and decreasing my Lithium dose while I was taking the Geodon.

It was frightening when the voices returned, since I was afraid after every returning episode that the voices might not ever leave permanently.  After several months of this, Dr. K decided that the Geodon just wasn’t working for me.

Because of the terrible side effects of Lithium, he didn’t want to return me to that drug on a permanent basis. Since Geodon wasn’t working, he decided to try a drug with fewer side effects than Lithium, but whose success rate was greater than Geodon. That drug was Risperdol, whose generic form was Risperdone.

He started me on .5 mg of Risperdone, at a cost of about $100 per month for a 30 day supply, and that seemed to work fairly quickly.  But although the side effects of Risperdone are less severe than those of Lithium, they are still fairly severe. Those side effects included a less severe case of  slowed intellectual functioning and weight gain as well as sexual dysfunction and a sense of “flatness” of life in general.  But at least the voices were gone.

After about 2 years on Risperdone, I came to realize that I continue to have the occasional “breakthrough” voice, no matter what I do.  I have come to accept the “breakthrough” voices as part of my life, rearing their ugly head whenever my stress level gets too high. But I am much more comfortable with those voices, realizing that they do indeed to away after a little while.

Lately, though, I came to realize just how “flat” my life had become, registering neither excitement nor fear even in extreme situations.  I am fed up with this side effect, as well as the other side effects.

Coming to terms with the voices has allowed me the freedom to once again try Geodon, since the unwanted side effects of Risperdone are so much more severe than those of Geodon.  So Dr. K and I decided to try Geodon once more.

Although I am wary of hearing voices once again to the extent I heard them when I was on Geodon before, I am willing to try it again because I am in a much more stable place than when I first tried it, and because I am resigned to hearing voices occasionally, just like I hear them with the Risperdone.

So with trepidation, I went to my local pharmacy, Fred Meyer Pharmacy, to get my new prescription filled. However, I was shocked at the price: $598 for a one month supply. That is insane.

If the Geodon works, the voices will be gone for the most part, my sex drive will return, my weight will stabilize, my intellect will improve.  And most importantly, my life will lose its “flatness”.  I miss those emotions of happiness, sadness, fear, surprise. Is it worth almost $600 a month to have them?  I think so.  But it’s unfortunate that people without the means to pay for Geodon will be stuck.


Paranoid Schizophrenia: Worst Disease in the World October 21, 2010

Posted by Crazy Mermaid in mental illness, Psychotic, Schizophrenia.
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Paranoid schizophrenia is the absolute worst disease known to man, bar none.  It reduces its target to a mass of terror about the world around him. Loved ones become enemies. Everyone becomes enemies. And if it’s not caught in time (which is most of the time), there is nothing to be done for the person with the illness.

Combined with severe paranoia about the world around him, convinced that his delusions and hallucinations are real, the paranoid schizophrenic’s life is a living Hell.  Unable to see that he is ill because of one of the symptoms of the illness (anosognosia), he is trapped forever in that horrible world.

Yet another paranoid schizophrenic young man has committed a crime because of this illness, and nothing can be done about it.  Joshua Rockwell, a young man of 25, has been accused of armed robbery at Alderwood Mall in Lynnwood, Washington. http://www.heraldnet.com/article/20101021/NEWS01/710219819/1122. But it’s not what you think.

It is logical to assume that the young man robbed a store.  But that wasn’t the case.  He approached  a couple in their late 70’s who were celebrating their wedding anniversary. Holding a knife to the husband’s stomach, he ran away with the woman’s purse. He has spent the months since that incident in  jail, as his family hopes that he will get treatment for his illness.  No luck so far.

I’m sure his robbery was a direct result of his belief that he was being terrorized by the bad guys. I know because a similar incident happened to me as I slipped further into my psychosis.

During the tail end of my psychotic break with reality, I came to believe that there were zombies after me, ready to kill me in order to take over my body. My fear of them taking over my body eventually became so great that I decided to go to the local hospital emergency room, where I thought I would be safe from them.

Once at the hospital, I changed my mind about wanting to be there, convinced by the voices in my head that there was a conspiracy going on to imprison me there.  The fact that they refused to allow me to leave the hospital led fuel to the fire. Then, after I took off my clothes and refused to put on a blanket or robe, I was brought into a private (locked) room, where I did my best to get released by throwing furniture up against a door in an effort to break its glass window so I could leave. I threw the furniture on the advice of my attorney, one of the many voices in my head.  He told me the hospital couldn’t legally hold me, and that I needed to throw furniture in order to make them let me out.  Of course my plan didn’t work so well. At that point, I had unknowingly demonstrated that I was a danger to myself and others, and crossed that threshold into the land of involuntary commitment.

As I sat there in that locked  hospital room, waiting for God knows what to happen to me, I “realized” that I was being irradiated so that Haliburton could make a bomb out of my body. I feared for my life, sure that I was doomed,  illegally locked in a room and unable to do anything about it.  It was frustrating and horrible.

While I only experienced that paranoia for a short while, I can relate to those poor souls who experience this fear as part of their daily routine. What an awful existence, living in terror that someone is out to get you, to murder you, to steal your soul. And knowing that nobody will believe it, or, even worse, that they are part of the conspiracy, wears on you. You can’t sleep, you can’t believe what anyone says, and if you tell anyone what is going on, they accuse you of being sick. And then they want to medicate you.

You realize, only too well, that a medicated you, wrapped in a chemical straight-jacket, is an easy target for those wanting to hurt you. So you do the obvious thing:  try to avoid medication at all costs.  And those who want to medicate you have just exposed themselves as your enemy, no matter who they are or what they say to try to convince you otherwise. You’re in an unwinnable situation, about to undergo a more terrible situation that the one you’re in if you once cave in to them. So you fight with all your might.  You fight for your life. For your very soul.  And the more you fight, the more they try to put you into a straight-jacket, either physically or mentally.  It’s a fight that wears on you through the months and years, alienating you from your environment.

And you see evidence of your belief that everyone is out to get you everywhere you look.  In my case, I actually saw zombie people, including young children and babies, pass me as I walked towards my beloved swimming pool at the YMCA. Their existence was proof positive that they were the enemy, waiting to grab me and turn me into one of them at their first opportunity.

That fear and terror was a horrible thing to live through, and if it weren’t for my involuntary commitment, and subsequent mandatory medication, I would still be living in that world where everything engenders fear.  I was one of the lucky ones who was released from that world, with the help of legally mandated medication.  I lived to tell my story, in the hope that with understanding there will come treatment for what I consider to be the worst disease in the world.

The World Is Flat October 17, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Medication, mental illness.
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It’s an obvious point, but the point of mood stabilizers is to stabilize moods.

What’s not so obvious is the unintended consequences of mood stabilization.  When your mood is stabilized, it makes life flat. Nothing makes you sad, but nothing makes you happy either.  That fact hit me squarely in the face this week when we bought a new house.

While the purpose of the mood stabilizer is to avoid manic or depressive episodes that are so characteristic of bipolar disorder, there is a down side to the medication.

When you get ready to purchase an object of the magnitude of a new home, a normal person goes through various stages of emotion.  The process of finding a home should  be filled with excitement, both good and bad.  Excitement at finding that perfect place to live. Excitement at seeing that perfect house for the first time in person.  Excitement at going through that perfect house for the very first time. Excitement at making the offer, then getting the offer accepted by the seller.  All of these processes elicit a roller-coaster of emotion in the normal person.

But in the medicated, stabilized bipolar person, these emotions are missing. Where there should be trepidation at undertaking such an enormous obligation as a house payment, there is an absence of fear.  There is no thrill of getting a good deal, of finding the perfect place to live. There’s just nothing there. It’s flat.  Neither up nor down.

In the old days before my illness, I would have taken a great amount of interest in the whole house-hunting process. The thought of spending that much money would have sped me into action, to make sure that we got a good deal for our money, to make sure I wanted the house.  But this absence of emotion has had a profound effect on the degree of my involvement in the whole house-hunting process.

When I can’t get excited about the house-hunting process, I can’t get emotionally involved in it either.  I stand apart, waiting for my husband to make all the moves, all the decisions, in this major undertaking.  I watch, like a spectator, rather than as a partner, as he signs us up to the bottom line of a major monetary commitment. It simply doesn’t matter any more.

I miss the old days, when I had the rush of excitement of the hunt.  Looking for the perfect house, excitement at finding a possibility. The thrill of stepping over the threshold of what might prove to be our next home.  Will this be someplace I would want to live? Do I like the house? Love it? Or hate it? How do I feel about it?  How do I feel about the entire process of house-hunting?  About committing the money to purchasing it?

The answer to these questions is: nothing. I have no feelings about any of it.

While the mood stabilizer keeps me on an even keel, able to avoid manic and depressive episodes, it also keeps my life flat.


Mental Illness Medication Side Effects October 12, 2010

Posted by Crazy Mermaid in Medication, mental illness.
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Friends and loved ones of those with a mental illness have a hard time understanding noncompliance with medication.  Why, they reason, if the drug helps control the symptoms of the mental illness, doesn’t the mentally ill person take the medication?

One of the biggest reasons for noncompliance is the side effects of the drugs. Especially for those with more severe cases, the side effects of strong doses of medication can cause horrific side effects. So horrific, in fact, that the patient makes the conscious decision to stop taking the medication to avoid those side effects. Living with the mental illness becomes more appealing than living without it.

In order to get an understanding of exactly what those horrific and debilitating side effects are, I have highlighted the ones that affected me when I became medicated.  Although these side effects settled down after about 4 to 6 months, there was no way of knowing exactly how long I would have to put up with them. As it turns out, six months is a long time to live with them. And in some cases, such as non-Parkinson’s, there was the possibility that the side effects would become permanent.

I can safely say that were it not for the patience, cajoling, and encouragement of my family, I, too would have joined the ranks of those who refused to take their medication due to the debilitating side effects. Here, then, is a look at some of those side effects that I personally experienced.

Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the extremities may also occur. Impaired movements of the fingers may also appear. Patients with tardive dyskinesia have difficulty not moving.

Tardive akathisia involves painful feelings of inner tension and anxiety and a compulsive drive to move the body. In the extreme, the individual undergoes internal torture and can no longer sit still. It is a syndrome characterized by unpleasant sensations of “inner” restlessness that manifests itself with an inability to sit still or remain motionless. Akathisia may range in intensity from a sense of disquiet or anxiety, to severe discomfort, particularly in the knees. Patients typically pace for hours because the pressure on the knees reduces the discomfort slightly, then they sit or lie down, because of fatigue in the knees. The feeling is there from wakeup in the morning to sleep at night.  High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture. (Note: this made me feel like I was going to crawl out of my own skin).

Non-Parkinson’s disease mimics Parkinson’s Disease, which is  a degenerative disorder of the central nervous system that often impairs the sufferer’s motor skills, speech, and other functions It is characterized by muscle rigidity, tremor, postural abnormalities, gait abnormalities, a slowing of physical movement (bradykinesia) and a loss of physical movement (akinesia) in extreme cases. (Note: this was absolutely horrible.  I have a new understanding at how those with Parkinson’s must feel, and how lucky I am to have come out of it without permanent symptoms).

While research is underway to find medications with fewer side effects, the process is slow, cumbersome and expensive. But with newer therapies able to target specific regions of the brain through the application of relatively new brain imaging techniques to subjects, I hope that progress in this realm can be sooner rather than later.  Because if we can reduce the degree of debilitation of side effects of medication, we can increase the number of people willing to stay on their medication regimen.  Imagine what the prison population and homeless population would look like if the mentally ill currently among them were to become medication compliant. How different this world would be.

LSD and Mental Illness October 8, 2010

Posted by Crazy Mermaid in mental illness, Mental Illness and Medication.
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Everyone knows that LSD is a dangerous drug, capable of driving us out of our minds.  We’ve heard this refrain all of our lives:  LSD is the most dangerous of the dangerous drugs. Stay away from this drug at all costs.

But new evidence suggests that we reconsider this idea. It’s quite possible that this drug is a solution rather than a problem. Instead of driving us out of our minds, new evidence suggests that LSD is capable of restoring a sense of sanity to the insane.

Even in the early 1960’s the drug began to change the face of psychology as we know it. Prior to this, it was common “knowledge” that mental illness was caused by environmental factors.  For example, bad parenting, the theory went, was responsible for schizophrenia.

But LSD’s ability to induce psychotic symptoms in otherwise perfectly normal people gave rise to the concept that chemical changes in the brain were causing the psychotic symptoms characteristic of certain mental illnesses such as schizophrenia.  A paradigm shift in thinking about mental illness resulted, and we began to seek solutions to the terrible symptoms of mental illness in pharmacology.

So how did a drug with so much possibility end up on the short list of the most dangerous drugs in the world?

First synthesized in 1938, the drug was made illegal in the United States in October 1968 after it became synonymous with out-of-control counterculteralism of the 1960’s.  The last FDA approved human study with LSD, for use in dying cancer patients, ended in 1980. Even Switzerland stopped its use in 1993.

But today, we are reconsidering the advisability of this action.  Banning a promising drug because of social unrest associated with it seems unwise at best and foolish at worst. As it turns out, current research points to successful use of LSD and other psychotropic drugs to reduce the clinical symptoms of mental illness such as bipolar disorder, schizoaffective disorder, and schizophrenia.

In the mid-1990’s Franz Vollenwider’s research showed that LSD, combined with behavioral therapy, could alleviate the symptoms of various psychiatric disorders such as schizophrenia and bipolar disorder. With the ability to study the effects of the drug using new tools such as functional magnetic resonance imaging, scientists are now able to use the new technology to see which areas of the brain are specifically affected by the psychotropic drugs. With this new knowledge, they will be able to make inroads into new treatment options for mental illness, including the administration of LSD.

It’s time to dust off the medicine cabinet and take another look at LSD and other psychotropic drugs. This is 2010, not 1960. We can’t afford to hold possible cures to mental illness hostage to long-ago prejudices.