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Ketamine: The New Wonder Drug August 25, 2013

Posted by Crazy Mermaid in Depression, Medication, Suicide.
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At our recent NAMI Washington conference in Ellensburg a few weeks ago, the most exciting thing I heard about was a drug called ketamine.  It’s a drug that relieves severe depression symptoms almost immediately. It would save the lives of the 35,000 people who die of suicide in the United States each year and substantially improve the quality of life of those who suffer from depression.

But with all of the promise this drug elicits, the problem is that there aren’t enough studies to warrant adding “antidepressant” to its list of “on-label” uses.  The best we can do right now is administer it as an “off-label” use at hospital emergency rooms or mental hospitals, which is where suicide wanna-be’s show up, or at psychiatrist offices, where people with severe depression seek help.  ketamine for blog

Ketamine has historically been used as an anesthetic in humans and animals, and its antidepressant quality was accidentally discovered when people undergoing surgery experienced a lifting of their depression upon awaking or shortly thereafter.  The antidepressant effect was traced to ketamine. 

Further studies, though limited in quantity, confirmed that 70% of people given ketamine injections experienced substantial relief of their depression symptoms after administration of this drug- some in as little as 2 hours after the drug was administered. That’s a world away from the 4 to 8 weeks needed for a traditional antidepressant to work.  It can mean the difference between someone committing suicide and staying alive. Or it can mean a substantial improvement in quality of life for those suffering from depression.

One of the problems with getting enough documentation in order for the US Food and Drug Administration to approve ketamine as an antidepressant is that the drug is an old one, with an expired patent. That means that no drug company is willing to spend the money necessary to finance drug studies to prove the drug works as an antidepressant. 

Although the cost of an injection seems like a lot of money to us,  (about $900) that’s not enough money to entice drug companies to spend vast sums necessary to administer the necessary testing. So, instead of the traditional path through drug companies, testing will have to be done through grants from the National Institute of Mental Health or other bodies like that, with no financial interest in selling the drug.  The best we can hope for from the drug companies is an isolation of the mechanism that works in ketamine, and a new drug developed from that mechanism.  That could take years. In the meantime, its antidepressant use must be limited to “off-label”.

One of the challenges associated with ketamine is that it has an unfavorable image as a “club drug”, a drug used by young people frequenting clubs to get high.  When used in large doses, it induces an out-of-body experience, something drug users are attracted to. This use impacts the politics of the drug, since no one wants to be caught developing a drug like LSD.

Since I haven’t seen him since my conference, I haven’t had the opportunity to talk with my psychiatrist about this drug.  That conversation will be interesting. Stay tuned.

Read more: http://healthland.time.com/2013/05/22/club-drug-ketamine-lifts-depression-in-hours/#ixzz2cocrOXXb


Insulin Shock Therapy December 3, 2012

Posted by Crazy Mermaid in Medication, Mental Hospital, Schizophrenia.
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In a desperate attempt to find a cure for mental illness in the early part of the last century, barbaric treatments were invented. Insulin shock therapy was one such treatment.

In insulin shock therapy, a patient was put into an insulin coma six days a week for months on end in an attempt to “cure” schizophrenia by “resetting” the brain. Occasionally that seventh day was filled with electro-shock therapy. Sometimes this “treatment” went on for years.

Insulin shock therapy was started by psychiatrist Manfred Sakel in 1927 when he began to use low (sub-coma) doses of insulin to treat drug addicts and psychopaths in Berlin. Interpreting his results as successful, he got the idea of “resetting” the brains of schizophrenics using the same therapy. News of his work spread, and this treatment was picked up by mental hospitals worldwide.

After being injected by insulin, patients experienced various symptoms including flushing, pallor, perspiration, salivation, drowsiness, or restlessness before falling into a coma. Each coma lasted for up to an hour and was terminated by intravenous glucose. Seizures sometimes occurred before or during the coma, and these were viewed as positive events.  Only the healthiest patients were chosen for the treatment, since it was so hard on their bodies. Broken bones were common.

For years, this “therapy” was performed on the mentally ill, including John Forbes Nash, the brilliant mathematician whose life story is told in A Beautiful Mind by Sylvia Nasar. The book goes into a little detail about his treatment.

Insulin shock therapy started to fall in disfavor when Harold Bourne, a British psychiatrist, published a paper entitled “the insulin myth” in Lancet in 1953, in which he debunked the therapy.  Then, in 1957, Lancet published the results of an experiment whereby insulin shock treatment was shown to be an ineffective treatment for schizophrenia.  Over the years, it slowly began to fall into disfavor, and is now thought of as barbaric.

It is relatively easy to see why insulin shock therapy was quickly adopted by the mental health community.  Up to that point, there was no other treatment available. Anything that had a remote possibility of working was greeted with open arms, and the “science” behind the treatment made perfect sense. “Resetting” the brain would result in curing the illness, they reasoned.

Eventually, science caught up with insulin shock therapy, and the medical community was forced to abandon this treatment, but not before much pain and suffering occurred.

In the future, it will be interesting to see which of our current therapies are viewed as barbaric as insulin shock therapy and lobotomies are viewed today.

Geodon Went Generic April 24, 2012

Posted by Crazy Mermaid in Medication.
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Geodon just went generic, and this is a wonderful thing.

For mental illness, the sequence of drugs prescribed has been as follows:  Lithium is for those in an especially bad place. Then, once the crisis is averted, the patient up until now was put on risperidone, a generic form of Risperdol which went generic back in June of 2008. Geodon, at least in Washington State, has not been prescribed by doctors because up until now the name-branded drug was prohibitively expensive.

I discussed the difference between generic drugs and name-brand drugs in my article “The Cost of Generic Drugs versus Name Brands: Lamictal” back in 2009 when Lamictal went generic. That article talks about the cycle between name-brand Lamictial and generic lamotrigine.  Lamotrigine is now coming in at around $21 per day, which is still obscene,  but at least is less than when the drug was name-brand.

The same thing that happened to Lamictial three years ago is happening to Geodon now.  But the difference is that for Lamictal, there was no alternative drug like there is for Geodon.  Because generic Geodon will be prescribed more often than risperidone (now that the price has dropped), the difference in care will be enormous.

In terms of side effects, the worst drug of the three is clearly lithium.  Although it has been used for years, the side effects are tremendous, which is why people don’t want to stay on it.  For me, the side effects included something along the lines of a faux Parkinson’s, including losing my muscle control and gaining weight, as well as feeling groggy and lethargic and unable to think clearly. Sometimes these side effects are permanent. That is one of the reasons I would have chosen unmedicated mental illness rather than long-term lithium use had lithium been my only choice.

Risperidone has fewer side effects than lithium, but it’s far from a perfect drug. Weight gain and fuzzy thinking and reasoning are two reasons I didn’t like risperidone. Geodon is a much better drug because it has fewer side effects. The difference in quality of life between Geodon and risperidone (generic Risperdol) can’t be emphasized enough.  With Geodon, a person will be much higher functioning.  Geodon will be the difference between being able to hold down a job and having to stay on public assistance because mentally ill people function at a lower level on Risperdone than they do on Geodon. People on risperidone will have more health problems because of the tendency of Risperdone to cause weight gain. And there are those who prefer unmedicated mental illness to weight gain, so they don’t take their medication. I have met people who have gained fifty and one hundred pounds on risperdidone, in addition to having low or no libido and fuzzy thinking.  The additional weight, of course, contributes to poorer health and quality of life.

The interesting thing about Geodon is that after the drug went generic, the price for name-brand Geodon dropped significantly.  It went from $34 a day for the name-brand drug in January 2012 (when there was no competition) to $125 per month now ($4.20 per day).  The price for the generic form is significantly less at $.50 per day.   This turn of events, going from brand name to generic, is obscene, and I won’t discuss it here.

The positive impact on quality of life will be significant for the person now able to take the generic form of Geodon because the price has dropped so much.  People’s health will improve in part because Geodon acts as an appetite suppressant (for me), causing me to actually lose weight as opposed to risperidone (that caused me to gain weight).  In addition, Geodon allowed me to reason and think better than risperidone, and now that the cost is so much less, people with terrible or non-existent insurance (and those on public assistance) will have the benefits of this now-generic drug. Doctors who treat those on public assistance will now have the ability to prescribe this drug for their public assistance patients, which will cause those patients to become higher-functioning, possibly even able to hold down a job and get off public assistance.

I know it will change people’s lives for the better, and I am thrilled that it is now affordable for the vast number of Americans.

Depression and the Holidays December 21, 2011

Posted by Crazy Mermaid in Depression, Medication, mental illness.
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Traditionally, this is the time of year that heralds short-term depression. Not clinical depression, but event-caused depression brought on by too-high expectations. For whatever reason- be it unwanted relatives, too much to do and too little time to do it in, or financial problems- life isn’t good for one reason or another.  Generally speaking, problems with families or money problems lead to a case of depression.  But make no mistake:  this kind of depression is seasonal and temporary and not as debilitating as the clinically depressed.

Major depression, or clinical depression is a serious medical illness affecting 15 million American adults, in a given year. About 8% of the population is clinically depressed at any given time, and 16% will have a bout of clinical depression in their lifetime.

Major depressive disorder is a disabling condition that adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide  and up to 90% of people who committed suicide had depression or another mood disorder.

Unlike normal emotional experiences of sadness, loss or passing mood states, major depression is persistent and significantly interferes with an individual’s thoughts, behavior, mood, activity and physical health. Clinical depression differs from short-term depression in several major ways.  It impacts the ability to function, affecting everything from sleep cycles to weight loss or gain to not enjoying the present.

In some cases, for example if the person is genetically predisposed to clinical depression or suffers from post traumatic stress disorder, short-term depression becomes clinical depression.  While the best way to prevent clinical depression is to minimize or eliminate short-term depression, doing this doesn’t preclude the possibility of it.

I have had one bout of clinical depression. It was when I was on massive doses of Haldol when my psychiatrist tried to stop me from having horrible visions. At the time, I couldn’t get out of my head pictures of gore and even murder and the voices in my head were exceptionally loud.  When I called Dr. K’s emergency number and told him what was going on, he prescribed 5 mg of Haldol twice a day.  To give you an idea of how much Haldol he gave me, the normal dose is .5 mg once a day.  But the alternative was going back to the mental hospital, which I had only left a week  before.  So I agreed to this treatment.

After about 5 days, the feeling of clinical depression came over me, but I didn’t recognize it. At first, I couldn’t get out of bed. Then I sat around and cried.  I had no reason to cry, even crying on my 25th wedding anniversary while we sat outside at a lovely restaurant in the middle of a beautiful summer day.  After a few days of continuous crying, my thoughts turned to suicide.  I so badly wanted to take a loaded handgun and blow my brains out that I would have done it in a heartbeat had I had the guns in the house. Incidentally, one of the requirements of my release from the mental hospital was that I had to get rid of all of my guns.  As a hunter, I had two shotguns and a rifle in the house before they made me get rid of them. Now I know why.

Anyway, when I became suicidal, my sister and husband insisted that I call Dr. K to tell him what was going on.  The only thing I could think of was that I didn’t want to “bother” him so I didn’t want to call him. Finally, after they threatened to call him if I didn’t , I called him. He immediately reduced the Haldol. Funnily enough,  I was willing to commit suicide but I wasn’t willing to disturb my doctor. Go figure.

Having suffered a major episode of clinical depression, I am empathetic towards those experiencing it . I wouldn’t wish it on my closest enemy.  It wrecks your quality of life and the quality of life of those surrounding you.

I can’t get the statistics out of my head. For example,  ninety percent of people who “successfully” commit suicide are depressed.  I am more convinced than ever, given my experience, that clinical depression is actually a case of a chemical imbalance of the brain and is nothing to be embarrassed or shameful about.  Detecting it earlier gives the person a better chance of being able to control it, both by medication and psychotherapy.  I don’t know why the psychotherapy works, but I suspect it affects brain chemistry in the same manner that medication does.

In my blog, my articles are tied to search engines. They pop up when certain key phrases are written in a search engine. The saddest and scariest search engine terms I have repeatedly seen in my blog are “how to commit suicide without people knowing what it is”. Fortunately, my blog entryis more of a “prevention” article, citing all of the ramifications of the act, rather than be a “how to do it”.  But even having that term come up on my search engine term at all is sad and scary.

Keeping holiday depression away is the best way to avoid clinical depression. But if you find yourself clinically depressed, it is critical to seek immediate medical help.  A psychiatrist is preferable to a general practitioner because he is more experienced in mental disorders.  It’s like going to a gynecologist rather than a general practitioner for a pap smear.  The more cases he has handled, the better your treatment will be.  Just remember: You don’t need to have your quality of life affected by this mental illness.

A Case for Involuntary Commitment January 1, 2011

Posted by Crazy Mermaid in Involuntary Committment, Medication, Mental Hospital, mental illness.
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As part of my psychotic experience, I believed that I had ESP (extra sensory perception). I thought I had famous people as part of my entourage, hanging on every brilliant “word” coming out of my “mouth”. At first, these conversations took place entirely inside my head, without me uttering a single word.  However, towards the end of my psychotic experience, my need to talk out loud to them became very strong. Too strong to ignore.

Thanking God for Bluetooth technology, I decided that talking out loud to my friends would be mistaken by everyone who witnessed it as simply conversing on the cell phone, as long as I had my “ear bud” in my ear. So I began wearing my “ear bud” everywhere except to bed.

In this section from my memoir (called I Thought I Was A Mermaid), I had just driven to Walmart (really) to go shopping with my (imaginary) friends.

(Note to blog readers: As far as the people with me go, they were a mixed bag. Although I had never met the real Claudia, she was in fact a real person whom I had heard about and wanted to meet.  Mike was actually based on my (real) boss at Mortenson, where I was a project manager on a $55 million ice hockey rink under construction.  Bill Gates needs no introduction, except to say that although I had never met him in real life, my circle of friends (really) included someone who had (really) worked with he and Melinda Gates, his wife, at Microsoft back in the day.

Rolling into the colossal Walmart parking lot, I turned off the key.

Me: Here we are, everyone!

Claudia: I can’t believe how nice the cars are. I thought they’d be all dumpy and old and stuff. But they’re not too bad. Even a Lexus or two.(Note to blog readers: the people I conversed with could see through my eyes, so they saw exactly what I saw).

Bill Gates: I’ve never been to a Walmart before. But I know someone who has. And she’s dying to meet you. Oprah Winfrey, meet Kathy. Kathy, meet Oprah. I was shocked, to put it mildly.

Me: I never expected to meet you in a million years, Ms. Winfrey.

Oprah: Call me Oprah, Kathy.  And it’s very nice to meet you.

Me: It’s nice to meet you also.

Oprah: I’ve been hearing a lot about you, Kathy.  Bill and Melinda Gates are friends of mine. When I heard they knew you, I begged them for an introduction. And it’s so funny that I’d meet you here in a Walmart parking lot. I grew up with Walmart.


During my three week involuntary hospitalization (at Fairfax Mental Hospital), I continued to believe that I had ESP. The day I was released from Fairfax, I met my new psychiatrist for the very first time. After my meeting with him, I believed that I talked with him via ESP during my car ride home.

My point is that it took over a month for the medication, initially forced on me during my hospitalization, to finally kick in enough that I no longer believed I had ESP. Without involuntary commitment and its accompanying medication, I would still believe I had ESP and I would still be talking out loud to my imaginary friends. At first I fought tooth and nail, but in the end, involuntary commitment saved my family and I from a terrible fate.

Penny Smart, Pound Foolish: Stopping funding for Mental Illness Medication November 28, 2010

Posted by Crazy Mermaid in Health Insurance and Mental Illness, Healthcare, Medication, mental illness.
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Today I went to the pharmacy to pick up my 30 day supply of prescriptions for my mental illness.  My prescriptions consists of Geodon, Lamictal and a few other drugs. My total bill for 30 days of medication was $1057 per month. Multiplying that out by the number of months in a year, I spend $12,684 for a year’s supply of medication.

Then there’s the psychiatrist visit. If – and this is a big if- I don’t have any major emergencies like hearing voices, I can get by with seeing him about every 4 weeks or so.  That’s about $250 a month.  Then there’s my therapist.  She runs $125 an hour. I see her twice a month. $250 (it used to be weekly until the bill got too expensive).   Between my therapist and my psychiatrist, I spend another $500 a month for their services.  Don’t get me wrong: they’re worth their weight in gold.

The grand total for a year of care is $18,684.  With a price tag like this, it’s easy to see why medication for mental illness is an easy target for a Legislature turning over every rock trying to find ways to cut their budget. But doing so would be penny-wise and pound-foolish.

People who are used to having their prescription drugs paid for by Medicaid, will no longer be eligible for those drugs if these budget cuts go into effect. So what will the net result of this change be?

A significant portion of people with severe mental illness are on disability. Surviving on less than $12,000 per month, they will no longer be able to afford their medications or therapy. Heck, they would have to spend more than what they make in a year on medication if their subsidies went away. Impossible.  They will have to go without.

What does that mean for society as a whole?  It means that we will have a significant percentage of the severely mentally ill off their medications.  Although having the State pay for drugs for the mentally ill appears to be for the benefit of the person with the mental illness, in fact this is a matter of public safety.

Unlike someone who needs medication to thin their blood, a person with a severe mental illness won’t die if the drug coverage is discontinued. They won’t bleed to death or go into a coma without the drugs. So it’s attractive to the cash-strapped Legislature to cut out prescription drug coverage for the mentally ill from their budget. At a cost of thousands of dollars per person, it seems a logical way to save money.

But I hope the Legislature wakes up to this fact before it’s too late: mentally ill people need their medication for public safety reasons. If they’re disabled, they won’t be able to afford their medication without subsidies from the Government. They’re essentially unemployable because of their debilitating illness. They have no reserve of funds, living on the edge of poverty because of their disability.  Without Government interference, there’s simply no room in their meager budget for medication.

The Legislature needs to understand that the medication for the mentally ill is needed as much as or perhaps even more than someone who takes drugs to thin their blood.  If the guy needing blood thinners goes off his medication, there’s a good chance that he will suffer severe symptoms, including the possibility of his death. That isn’t the public’s and the Legislature’s perception of drugs for mental illnesses.

In fact, the un-medicated mentally ill are going to be much more expensive than the medicated mentally ill. Take me, for example. Without my medication, I would be in my own world, disconnected from my family and friends, lost in my own mind. I would once again be that mermaid, disrobing in public.  Trees would talk to me. I would once again believe I had ESP. But the main problem is that without my medication I would become a danger to society.  Believing that zombies are after me, or that I’m being held hostage or numerous violent scenarios will cause me to strike out at whoever tries to subdue me.

Imagine what the world would be like if suddenly all the people with severe mental illnesses- bad enough to be on disability- went off their medication at the same time.  What if the people on antipsychotics stopped taking them after their “free” supply ran out?  All of those psychotic people concentrated in Washington State won’t go quietly off their meds. They need those drugs to prevent their return to a psychotic state.

Washington State has the fewest hospital beds per capita in the Nation, so it’s not like we’ll have any room for the mentally ill in the mental hospitals. If they can get in, mental hospitals cost around $3,000 per day. But  before they go there, they’ll pass through the doors of a “real” hospital- likely the understaffed, overcrowded, cash-strapped emergency room. Think of it: a person in a psychotic state in a room full of sick people.

If they commit a crime, which many are likely to do, they will swamp the legal system and the jails. Police taking on the task of dealing with this situation will short-change other areas of their responsibility.  If you think medication is expensive, think about how expensive incarceration is. The last figure I remember reading is about $50,000 per year.

And what about the mentally ill people who injure others? A paranoid schizophrenic without medication will not be a pretty sight. Won’t those injured “sane” people and their loved ones appreciate what a good job the Legislature did by saving all that money?

I hope that the legislature comes to its senses before cutting those drug benefits.  I hope they recognize it for what it would be: a public health crisis.

Driving and Mental Illness November 22, 2010

Posted by Crazy Mermaid in Medication, Mental Hospital, mental illness.
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When I first began driving, I was a teenage girl living in Kihei, Maui, Hawaii. My dad was Project Manager for a mid-sized construction company named Red-Samm/General, a joint venture between two fairly large construction companies.  He was in charge of putting together a seven mile long sewer line through downtown Kihei.  In fact, I tell my friends that if they’re staying in Kihei and flush the toilet, they can thank my dad.

In those days, my dad came home from an extremely stressful job and started  “driving school for Kathy”. Things were different in those days.  There was no Driver’s Ed on Maui.

After working late, he drank a few beers and then threw me the car keys, saying “Let’s go”.  I climbed behind the wheel of a manual four wheel drive Jeep pickup truck, and he climbed in the passenger seat. As I learned where the gas and more to the point brakes were on that manual transmission, he sat in the passenger seat, holding on for dear life.  Anyone who has ever sat in that passenger seat can tell you it’s no picnic.  Around the Island we drove (it’s a 50 mile trip around the whole thing), driving on two lane roads out in the country lanes.

As I got older, I learned to drive other vehicles, eventually even owning a few of my own. Like my father, I taught my two boys how to drive (with the help of Driver’s Ed).  I became comfortable (and so did they) in my role as Driver Instructor.

During my career as both an owner of a mid-sized commercial general contracting firm and project manager of commercial buildings, I learned to operate heavy construction equipment, including (bull) dozers, backhoes, dump trucks, and skidders (used for logging operations).  My dad, also a project engineer but for sitework subcontractors until we went into business together, taught me how to operate all of these and more.

If there was any driving to do, I did it. I never let anyone drive if I could help it.

All that changed when I entered Fairfax Mental Hospital.

The initial dose of Lithium (900 mg) knocked me on my ass. I had major coordination problems, including doing what my husband calls the “lithium shuffle” up and down the locked down hallways of the psychiatric ward – where those of us who were involuntarily committed were housed.  I lost my sense of coordination, developed the typical side effects of massive doses of lithium, and lost my desire to drive anywhere.

As the Lithium gave way to Geodon and subsequently ,when Geodon failed to work, Risperdol, I continued to be uncomfortable driving.  In fact, when I got behind the wheel of the car on those rare occasions when I absolutely had to, I had trouble telling how far I was from the car in front of me. I couldn’t tell where the end of the car began.  I had trouble finding the gas and more importantly the brakes.  When I had to go to the local hospital where my gynecologist’s office is, I hit the gas instead of the break when I parked the car. It scared me so badly that I refused to drive myself anywhere for quite some time.

The Risperdol made things better as far as my coordination went, but still I avoided driving at all costs unless I absolutely had to. I felt much safer with someone else being behind the wheel.  I had neither the focus nor physical coordination to drive and I knew it.

Recently, with the switch from Risperdol to Geodon, I finally, two and a half years after my hospitalization, began to feel that I could actually be comfortable driving.  Yesterday, I am proud to say, I volunteered to drive my husband and I to the local Home Depot.  It was the first time in 2 ½ years that he had been in the passenger seat with me.

Everyone around me has been very patient with me, giving me the emotional support I needed to get to this stage.  But I am learning the joys of driving again, albeit slowly and cautiously.  It feels good.

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.

The World Is Flat October 17, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Medication, mental illness.
Tags: ,

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.
Tags: ,

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.