Sunday, November 25, 2007

Coming out of the drug closet

Ok, ok...I'll admit it. I'm a pharmacology nerd. I don't plan on dispensing drugs like candy once I'm a psychiatrist, but I personally take a handful (not just a figure of speech--literally a handful) of psychoactives everyday. And I've tried a lot of other drugs, too, in the search for the combo that gets me un-suicidal but not manic or numb/depersonalized, un-manic but not suicidal, not too anxious but not utterly the way, I'm not talking about uppers, downers, all-arounders, pot, acid, mescaline--I'm talking about prescribed drugs, which (in one of the curious contradictions of the free market) are several orders of magnitude more expensive than weed or crystal, and in some cases, more expensive than heroin or cocaine.

So what have I tried?

First there was Zoloft. Which I took for eleven years, from the time I was eleven (50 milligrams) which was titrated upwards to 250 mg when I was 22--by this time I finally decided it wasn't working for me anymore, even at above-PDR megadoses. I stopped taking it a few months ago, switching it out for a large dose of Effexor (which, coincidentally, I'd previously been on in combination with Zoloft). I did a 'cross taper' to prevent debilitating side effects of discontinuation, and stilll ended up having crazy out-of-body feelings and some severely severe depression. For a couple days I avoided driving, because (hand to God) I felt like I'd had 2 or 3 beers. And for the record, I'm one of those cheap dates who's already bobbing and weaving after one drink. I knew I wasn't paying attention to the road as I was driving, but I couldn't MAKE myself focus; I just didn't care--"You're just staring at the clouds. I think you--I mean I--should be looking at the road. But I don't really feel like it. Wow, that cloud looks like a fillet of asahi tuna." And then, once the Effexor got leveled out (and the depression continued), that got titrated up too. I noticed that I was losing more weight than usual, but the psychiatrist kept ramping it up anyway, and now I'm on a crazy-high dose (375 mg--usually reserved for psychiatric inpatient therapy).
Also taking gabapentin--what we once knew as "Neurontin," and what some docs are probably still foolishly writing 'DAW' for more than triple the cost. It was prescribed off-label as an antianxiety and antiobsessive; it's approved for nerve pain, specifically an after-effect of shingles called 'postherpetic neuralgia.' Oh, yeah--I'm on Depakote XR, too, off-label again.
And between those early days of Zoloft monotherapy and my current polypharmacy regimen, there was Wellbutrin (made me manic), Remeron (made me sleepy, and when I wasn't sleepy, a bitch on wheels--my mother finally made the doctor d/c it, because as she told the psychiatrist, "I can't live in the same house with her much longer if she stays on this medication. If you want to keep her on it, fine, but you're going to have to take her home with you."), lithium, which made me much happier/more even-keeled but also made me gain 30 pounds, Lamictal, which made me break out in a rash (and since that could be a precursor of a serious allergic reaction called Stevens-Johnson Syndrome, also made my psychiatrist d/c like there was no tomorrow) and Seroquel, approved as an atypical antipsychotic but often given to anxious folks with insomnia issues to help them chill. And, prn, a gift from the Goddess called lorazepam, or Ativan. It's one of the most potent benzodiazepines out there (packing several times the punch of Valium and its cousins). It seems to operate primarily on the assumption that if you're knocked on your ass you won't be anxious. Which is true, it's hard to have a panic attack when you're asleep. Interestingly, it's also used in controlling seizures-- especially during DTs (alcohol withdrawal), or with status epilepticus (when someone has a continuous seizure for a long period of time). AND it's an antiemetic. Whew! Beat that, Compazine! Lorazepam has a high affinity for GABA-receptors (recognize 'GABA'? Yeah, it's the same neurotransmitter that gabapentin plays with, explaining why both these drugs have somewhat sedating effects). So I've taken atypical antipsychotics (no, I've never been psychotic), SSRIs, SNRIs, atypical antidepressants, and benzos. Back in the day I probably would have gotten ECT and Elavil, had memory loss and had to give up cheese and wine. In some ways times have definitely changed for the better.

So screw the stigma. I'm not taking these to brighten an otherwise mediocre life; right now I need these in order to function. I want to come off them at some time in the future, but for now I'm over a barrel with the depression and the pharmaceutical companies. I'm not pleased about this, but I'm significantly more pleased than I would be if I were catatonic in bed.

1 comment:

Andrea H said...


Good luck with the pharmaceutical cocktails, I've been there too, although not for quite that long, and the entire time only wanted to get off them but needed them to function... minus that time [and the other times on top of it] when I ended up at the house passed out, unable to stand, and mumbling to Paul that he should fire me (were you there for that? It was mildly ridiculous... ahh the memories...). All because tolerance goes sooo far down when on medication.

The pharmaceutical industry is so f'ed up.