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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.

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 Cost of Generic Drugs VS Name Brands: Lamictal June 9, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Health Insurance and Mental Illness, Healthcare, Medication, mental illness, Mental Illness and Medication.
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The Cost of Generic Drugs versus Name Brands:  Lamictal

Although first approved by the FDA for treatment of  epileptic seizures in December 1994, Lamictal wasn’t approved for maintenance treatment of Bipolar 1 Disorder until June 2003. The first drug since lithium that was approved for this use, it is also used “off-label” for treatment of schizoaffective disorder, Bipolar II Disorder, borderline personality disorder, and Post-Traumatic Stress Disorder.

I was started on Lamictal in the mental hospital to treat the symptoms of Bipolar I, but my supply of medication ran out about 1 week after I was discharged.  When I got my prescription filled for a 30 day supply of Lamictal, I was shocked beyond belief to learn that the cost for that one month supply of 300 mg  was in the neighborhood of $450, or $5,400  a year.

In July 2008, Teva Manufacturing began offering a generic form of Lamictal in the 150 mg doses that I require.  Previously, it only made 25 mg and 50 mg doses, so it wasn’t practical for me to take 12 pills at a time in order to get the required 300 mg dose. When Teva began making the 150 mg pills in July 2008, it became practical to take two of them to equal my 300 mg dose.  At that point, my insurance company insisted that I change from the name brand Lamictal to the generic lamotrigine.  The cost of my medication was reduced from $450 per month to about $150 per month for 300 mg, or about $1,800 per year- a substantial savings of $3,600 a year,  but still out of the realm of most people’s idea of a bargain.

Now, almost 2 years later, I’m paying $14 for a one month supply, or $168 for a year’s supply of yet another generic form of  lamotrigine, this one manufactured by Cadila (Zydus). This drug is available to me through a mail-order prescription drug company, Medco, which is part of our insurance package. So what happened?  How can a drug cost go from $5,400 per year to $168 per year within a two year period of time?

In one word: generics.

But are they safe?  Are the generic formulas the same as the name-brand formulas?

To answer that question, I went onto the Federal Drug Administration’s website http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Reference%20Listed%20Drug to learn how the generic assessment is done. In a nutshell, the generics are tested on people just like the original brand-name drugs were tested, though the number of people they were tested on isn’t as large.  In the end, the FDA decides whether the test results are good enough to grant the manufacturer of the generic form of the drug approval to sell his drug, and makes that determination available online to the general public. In the case of lamotrigine, each dose, by manufacturer, has been tested and approved by the FDA (see http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=077633&TABLE1=OB_Rx).

In the final analysis, it’s up to the patient to decide whether the generic brand works as well as the name brand, but according to the FDA, the active ingredients are the same.

Is $450 a month an appropriate amount of money to pay for a medication?  Is it appropriate that the cost of the same medication varied from $5,400 a year to $168 a year within a two year period of time?  Is it any wonder that our health care costs are out of control?

Intra-Muscular Injections March 27, 2010

Posted by Crazy Mermaid in Involuntary Committment, Medication, Mental Hospital, mental illness, Psych Ward.
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At the mental hospital, although there was no alternative to taking the medication, there was an alternative to taking the medication orally. If you didn’t take the pills by mouth, you took them via “intra-muscular injections” – a fancy name for a shot.  Amazing as it sounds, some of the patients continually refused to take the medications by mouth, so they were given their medication by shot- over and over again.  Possibly as a side effect of the medications, some of the patients didn’t remember on a day-to-day basis that refusing to take the medications wasn’t an option.

Some patients refused their medications because they didn’t like the way the medications made them feel.  Because of the awful side effects, the patients became slow-thinking, fuzzy, or otherwise mentally impaired to the point that they wanted to discontinue their medications.  They would cry and scream and beg the nurses not to make them take the pills. Failing that plan, when the nurses still insisted that they take their medications, they resorted to praying to God (at the top of their lungs), asking His help to keep them from taking the pills.

Relatively soon, the situation deteriorated. The nurses could not allow the patients to skip the medication.  The medication had to be administered to the patient, either willingly or unwillingly. If the patient refused the oral medication, the nurses were forced to administer the medication via an injection.

After the patient’s last-ditch verbal effort to avoid taking the medication (by mouth) failed, the nurses had to prepare to administer the injection. When the patient saw the nurses make the necessary preparations to administer the injection, they once again begged the nurses not to make them take the medication.  By that time, several nurse attendants had arrived, having been summoned to help hold the patient down while the injection was given.  Once they arrived on the scene, they grabbed the patient and put her in a choke hold.  The patient was by that time wildly flailing about, trying to escape.

Once they grabbed the patient to hold her down, the patient started screaming at the top of her lungs.  Crying and pleading, she continued to beg the nurses not to give her the injection. Louder and louder her crying got, turning into screams. She started praying to God, begging Him to intercept, finally resorting to screaming her prayer to God. She screamed that the nurses were hurting her, she screamed that the nurses holding her down were choking her, and finally she screamed that those nurses were trying to kill her.  The administering nurse walked towards the patient, the long needle in front of her. She injected the needle into the patient’s ass while the other nurses held the screaming, crying  patient down.  The blood-curdling screaming continued throughout the injection process. Finally, when the injection had been completed, the patient was released.

The whole thing probably took about 15 minutes from start to finish. But by the time it was finished, everyone on the ward was upset. Our nerves were shot. It was as if each of us had undergone that process ourselves.  Everyone who heard it was extremely disturbed.  There but for the grace of God go I, we all thought. After one of those sessions, all the patients and staff were both so keyed up that all the patients were let outside for an unscheduled smoke break. Fortunately for all of us, those episodes were fairly rare- happening about twice a week.