Wednesday, June 29, 2011

Chapter 4 - The Joint and ECT - January Through February 2011

The joint, nut house, loony bin, the pen, centers for behavioural health...there are many names for a mental hospital, but my favorite is the joint. I have fortunately never been in prison, but a mental hospital has got be a close cousin. The one that I was admitted to had four wards - geriatric, drug addiction, psychiatric, and crisis stabilization. The ward that I was admitted to had almost every vacancy filled by a mixture of gender, age education level and social status. Some were depressed, some suffered from severe anxiety, some had already attempted suicide, and spill-over from the drug addiction ward because it was full.

Before entering the ward the staff confiscated everything and anything that could be used to hurt yourself or others. Shoe strings, belts, etc. Personal hygiene was pretty much limited to deodorant and toothpaste. Obviously, it was a safe environment. Each room, in the ward, had two beds, one shower, one sink and no doors. Privacy? Forget about it. It didn't matter if you wanted to be by yourself, you had a same sex roommate, and not one that was up to you to chose. Upon arrival and my bed assignment I considered myself very fortunate to have been assigned a roommate who was basically in my exact same situation. For whatever reason it made me feel better that I was not alone, and there was someone who I could talk to who knew exactly how I felt. To this day we are still in contact.

There is a schedule of events that everyone follows. Meal times, break times, therapy times, telephone times, shower times, medication times, lights out times. You get the picture - everything is pretty much structured and routine. Fun?...not at all. Safe...absolutely. The highlights were visiting hours 3 times a week. Even though the time was brief the feeling of being able to see your family and friends is not something I am capable of putting into words. The other highlight was smoke breaks. I don't smoke, but I dip snuff. This escape several times a day gave me something to look forward to and kept me going. Tobacco may rot my face off one day, but currently it is saving me.

You definitely meet people who are worse off than you though. There was a guy there who either lost or won a game of Russian roulette. There was another who had both wrists bandaged, Another with a nasty welt on his neck consistent with an attempt of hanging himself. One of my roommates tried cocaine, meth, pot, heroin and several other drugs all at the same time. Others their, sadly, just didn't have anywhere else to go. No home, no money, no family, nothing. It was sad to see them actually be kicked out of the hospital just to make room for others.

I think I saw my assigned psychiatrist (I will call him Duke Nukem) the following morning. Who, after taking the time to interview me, theorized that I was 1) very sensitive to medications, 2) Refractory (treatment resistant), and had 3) Hereditary Major Depressive Disorder. I was also told that because of all of this that I was exponentially at a greater risk of suicide than my father. Duke Nukem decided that I needed Trazadone for sleep and Welbutrin for everything else. Why Welbutrin? Because I have never tried it before, so let's give it a shot.

In addition, Duke recommended ECT (electroconvulsive therapy) because it is an alternative for both refractory depression and hereditary depression. You have to understand that in my current mental state that if someone told me that removing half of my brain would make me feel better then I would be looking for where to sign-up for the surgery.

Now my hopes were up! A possible cure via ECT! I was amped (pun intended). The ECT procedure is done in this particular mental hospital. Basically, you are anesthetized, given a very powerful barbiturate (muscle relaxer) that actually stops you from breathing and makes it necessary for the technicians to do it for you. The unipolar ECT procedure is when one electrode is placed on the side of your head (temple area) and one is placed on the top of your head, and anywhere from 200 to 450 volts are administered (depending on your particular threshold). "The main aim of Electroconvulsive Therapy is to cause a massive convulsion in the brain (a massive epileptic fit).  This is achieved by giving the brain an electric shock.  ECT machines are, basically, transformers which modify Mains Current so that it is transmitted to the patients skull in timed pulses." I guess this a way to rewire your brain. I am told that today's treatments are much more humane than of old, not what you see in the movies where the patient looks like they are being electrocuted and flailing all over the table.

The side effects of ECT that I experienced were severe cotton mouth a massive headache and memory loss. Short term memory loss is a reported side effect, and for that they do not want you driving a car as an example. Because you may forget which is the accelerator pedal and which is the brake pedal.  For me it was more than that. I still have trouble remembering most of 2010! I meet people who I think is for the first time and they look at me like I have pancakes on head and say "you don't remember me?" I read a book (The Lost Symbol) while I was in the waiting que for treatments. About a month after my last treatment I found the book and read it again...didn't remember a word of it from the first read.

I was in the joint for 2 weeks. Towards the end of the two weeks is when I began the ECT treatments. Duke Nukem decided to release me and continue the ECT treatments on an outpatient basis. My hopes were up!

It was a big relief to get to come home and at the same time very scary because you can't help but think that you are on a very shaky foundation. I was not fully recovered and my mind just constantly ruminated. One of the questions that they ask you every morning, in the joint, is "are you having thoughts of suicide?" Even if I wasn't just having this question asked kind of started the whole process over again. This question became a part of my own daily evaluation of myself. As time passed I began to realize a transition from suicide ideations to thinking of suicide just as subject matter. Never-the-less, at this point in time, the way I felt was generally not very good. I still did not have a very good sense of well being and I was no motivated or excited about anything other than getting better. I was counting on ECT being the silver bullet.

I did the outpatient ECT for a week and then was readmitted to the joint. I felt awful....again. Duke Nukem made some medication adjustments (Zoloft + Trazedone + Remeron) (later I read that Trazadone should not be administered in conjunction with ECT...hum) and I was told that the reason I wasn't recovering was because I neglected to schedule talk therapy. I thought electroconvulsive "therapy" + meds was enough. I ended-up spending another week in the joint before being released again.

By the end of February I had completed ECT for a total of 20 treatments, I kept my scheduled appointments with Duke Nukem (who also has an outside practice) and continued talk therapy with a therapist who was conveniently in the same office as Duke Nukem. On my final visit with the therapist she told me that my coping skills were really good. She also told me that I should perhaps be a therapist because she felt more than once that we should switch chairs.

I started to get suspicious of Duke Nukem when, at one of my appointments, he gave me some samples of a brand new med called Oleptro (extended release Trazadone) and told me to give it a shot. My suspicion was that I was dealing with yet another prescription pusher. My suspicion escalated when, at another appointment, he gave me some samples of Deplin which is basically a mega-dose of folic acid. Deplin is supposed to make SSRI's work better. So now Duke Nukem, who originally theorized that I was over sensitive to medications, has me on four different meds - Zoloft, Remeron, Trazadone and Deplin. Not to mention that Oleptro and Deplin are both $70 per prescription - after insurance. I concluded that the three antidepressants all target different chemicals in the brain (SSRI + SARI + a tetracyclic), and with the addition of ECT is why I tagged him Duke Nukem. It would appear as though if he unleashed enough different weapons on my brain that one of them was bound to work.

By the end of February I was beginning to feel better. Put that into perspective though. I am not at all feeling like I should, but I'm not in the joint and feel like the depression is beginning to be manageable. I went for my regular scheduled testosterone shot and one day after that I am crashing (bad) again. I call Duke Nukem. He sees me on an emergency basis and decides to cut in-half all of my med dosages. Within days I begin to feel better.

Now I am back to thinking about testosterone levels, and why something that should make me feel better is having the opposite effect. I have a conversation with a body builder friend, who is well versed in such matters. He is appalled that a my general doctor would prescribe a 1ML dose once a month. He says that this type of administration will cause my testosterone level to spike and then drop. He also says that my estrogen levels will increase along with the testosterone level. Basically putting me on a hormonal/emotional roller coaster. That's JUST what I need! I decide to get my testosterone level checked weekly to see what's going on.

Three days after the testosterone shot my level was at 1380 (that's massive). One week later the level is at 653 (still fairly high for a 44 year old), and three weeks later it was at 461 (fairly normal). During this time frame my depression progress was doing better. For now I think my theory that low testosterone is part of the problem is not valid.

This is also when I began thinking that why is it that when I put something into my body that helps most others (antidepressants, testosterone, B vitamins) actually makes me feel worse?

Thursday, June 23, 2011

Chapter 3 - Implosion - November 2010 Through December 2010

Symbyax is a combination of on SSRI and an atypical antipsychotic, and Frankenstein decided to put me on a 3mg/25mg dose. I began to feel an almost immediate improvement over the previous Effexor med. This decent feeling lasted for a few weeks then I began to trail off. So, Frankenstein increased the dosage to 6mg/50mg. This apparently was the beginning of the end. During this time frame I also began researching what else may be causing me to feel like crap. What I came up with is a possible link to low testosterone levels, so I went to a local lab and had my blood drawn to check my testosterone level. The result came back at 380. This is not abnormally low, but low enough to make me think that this could be the root of the problem.

For the last few years me, my wife and son have taken our vacation at or around Christmas time. This year we went to a tropical paradise called Punta Cana in the Dominican Republic. The vacation was just short of 2 weeks into the increased dosage of Symbyax. I am sitting on a beautiful white sand beach, with a nice foo foo umbrella drink, the temperature and humidity is perfect, not a care in the world and women don't seem to be shy about not wearing their tops. All of a sudden I begin having suicide ideations! WTF????

As the perfect vacation days go on "my kryptonite" is on a steady rise, the suicide ideations start getting worse and I begin losing my sense of well being. Never before have I experienced true depression until now. I e-mailed Frankenstein with my concern and asked what I should do...stop taking Symbyax? Here was the response. "The doctor does not think that the Symbyax is causing the suicidal ideations, nor does he want you to stop it.  To do so, could make things worse.  When you return home and you are still feeling this way, you should go to the ER, call 911 or call the mental hospital." Wow...that's some solid advise! You can almost feel the compassion and in-depth attempt at understanding.

I continued to feel this way upon returning home so I scheduled two appointments. One with Frankenstein and one with my general doctor. Frankenstein decided to switch my prescription to 10mg of Pexeva (Paxil). Not until a few weeks after this did I discover that my father was on Paxil when he committed suicide...that would have been nice to know, and perhaps a good psychiatrist may have investigated that as well.

I presented my testosterone results to my general doctor and he agreed that the level was low enough to warrant treatment. So he prescribed a 1ML once a month testosterone injection. I was tentative about this (just a gut feeling) so I just got the prescription filled, but didn't get the actual injection.

On December 30th the suicide ideations, my kryptonite, and a complete disconnection from my surroundings prompted me to try the testosterone injection.

On December 31st I didn't think my situation could get any worse, but it did. What does depression feel like to me? Imagine having the worst hangover of your life, except it won't go away. Imagine being in a small tunnel that has no light and as you approach either end of the tunnel it gets smaller and smaller, but the entrance and exit are closed. Imagine being in a deep well that the water in the bottom of it is too deep to stand in and have your head out of the water. The sides of the well are dirt/mud and as you try to climb out it's too slippery for a hand or foot hold and you have to revert back to treading water.

January 1st 2011...Happy New Year! I am a runner, and running is a bit like meditation for me. It's a time when I seem to be able to think things through, come up with solutions to problems and generally just feel better (endorphins). That morning I went for a run, and none of the above happened. This was the point in time where I knew I was going to have to get some help or end up just like my father.....dead.

When I returned home, from my run, I took a shower, got dressed and told my wife that she needed to take me to the local mental hospital. Her look of concern, shock, helplessness and compassion is one that I will never forget. Once we arrived at the hospital and a staff member interviewed me it was immediately decided that I came to the right place and should be admitted.

Happy New Year!

Tuesday, June 21, 2011

Chapter 2 - Frankenstein - October 2007 Through October 2010

In October 2007 is when I joined the ranks of seeing a psychiatrist. I remember filling out a questionnaire in the office lobby and then directly went to visit the doctor. I am skeptical that the questionnaire was even looked at as he took no time at all to prescribe me Effexor (150mg).

I have maintained a daily rating scale, of how I feel, since this all began and up until now I was averaging in the low 90% (100% = I feel perfect). The low 90's is not to bad right? As soon as I went on Effexor the daily scale began to drop into the low 70's. What is the psychiatrist solution to this? Up the dosage, of course, and when that doesn't work let's try some add-ons. Don't deviate from Effexor though because that might interrupt any kick-backs being received from the pharmaceutical company!

Here is my trip through Effexor and various add-ons with "how I felt" off to the side.
Effexor 150mg = 75%
Effexor 225mg = 83%
Effexor 300mg = 82%
Effexor 150mg + Lamictal 50mg = 88%
Effexor 150mg + Lamictal 100mg = 89%
Effexor 150mg + Lamictal 150mg = 90%
Effexor 150mg + Lamictal 200mg = 88%
Effexor 150mg + Lamictal 50mg = 88%
Effexor 150mg + Resperidone 1mg = 88%
Effexor 150mg + Depakote 500mg = 87%
Effexor 150mg + Depakote 750mg = 80%
Effexor 150mg + Depakote 1000mg = 87%
Effexor 150mg + Depakote 1500mg = 86%
Effexor 150mg + Geodon 40mg = 67%
Effexor 150mg + Seroquel 50mg = 70%
Effexor 150mg + Seroquel 100mg = 75%
Effexor 150mg + Seroquel 150mg = 70%
Effexor 150mg + Oxcarbazepine 450mg = 70%
Effexor 150mg + Nortriptylin 450mg = 80%

Looking back at this data is where I have realized that the psychiatrist, who I tagged Frankenstein, was just trying different stuff on me. With a mentality of well that medication didn't work let's try something else. His experiments were based on what works for others (most of the time) will certainly work for me. Wouldn't it have been novel to actually try and figure out WHY certain medications were not working instead of using me as a human pin cushion?

I realize that trying different types of medications (SSRI's, SNRI's, anti convulsants, atypical anti psychotics, tetracyclics, atypical/norepinephrine-dopamine reuptake inhibition, etc.) is one way to try and figure out what works. But, this back door approach where I am the test subject just really pisses me off! Never once was there a blood test done to actually determine if I am deficient or over producing some needed chemical.

The next crazy psychiatry trial was to stop Effexor and introduce Symbyax. Here is where it starts getting really interesting.

Monday, June 20, 2011

Chapter 1 - My Kryptonite - 2005/2007

I have always been shy, not painfully, but not a social butterfly. I am the one who supports others..greases the wheels as they say. I am not a salesman, but have always done better socially when a little alcohol is involved. I have never felt typical depression symptoms like self worth issues, the blues, hating myself, etc., and definitely never had suicide ideations. Nor do I have any reason to be depressed (situational). I have a great wife, a great son, a great job, and hobbies that I enjoy. Don't get me wrong because I experience life with its ups and down, but still I have never felt the typical depression symptoms. The so called depression gene is present in my family. My father took his life when he was 50 years old. His father also committed suicide. So, I am not in denial of the potential for disaster.

What I do feel is a sort of fatigue. It comes and goes at random times. Sometimes it is an hour, and sometimes it is all day long. The best way I can describe the way I feel is similar to a hangover or jet lag. I call it "my kryptonite" because, not that I'm Superman, but to put it in perspective it is like if I were Superman then I get too close to a piece of kryptonite. My energy is drained, my motivation is lost and I just feel like total crap. The only relief is to go to sleep. Sometimes when I wake up the feeling is gone, sometimes not.

Once I exhausted myself trying to pinpoint if I had some kind of allergy and/or vitamin mineral deficiency I went to my general doctor. He scratched his head, looked at me like I was weird then prescribed Celexa (Citalopram), and told me he thought it was probably depression.

I began to keep a fairly detailed journal titled "How Do I Feel". It contained an analysis of daily life variations including adherence to a good diet (I follow the Zone principles by Dr. Barry Sears), tobacco usage (I dip snuff), alcohol consumption, social activity, stress at work, stress at home, the weather, how regular (poop) I am, sleep and physical activity (I am a pretty religious runner).

Unfortunately, from three years of data, I could not link a particular event to what would make me feel bad. I stayed on Celexa for about 18 months, and knowing what I do today I actually felt pretty good - most of the time. I continued to have "my kryptonite" episodes and probably should have just accepted that.

I must have missed a dose one day because I remember feeling light headed and kind of dizzy and thought this is not good. So I made an appointment with my general doctor to figure out what's up. He recommended that I go see a psychiatrist who could do a better job of tweaking medications.

Hind sight is 20/20, but I think this is the time when things started to go all wrong. Four years later, knowing what I do now I feel completely stupid for complaining about feeling dizzy one day!

Wednesday, June 15, 2011

Refractory..Treatment Resistant Depression

Is there anybody out there who has fell victim to modern day psychiatry? What I mean by that is today's phychiatrists seem to spend 10-15 minutes with you once a month and diagnose a mental condition that may or may not exist by prescribing medications. If (and that's a big IF) a particular medication works then I'm happy for you. But if the med doesn't work then they try changing the med or prescribe add-ons in attempt to relieve the symptoms of the condition. Once the Dr. exhausts his/her trial and error technique and you don't feel any better then they just recommend another Dr.

I have been on 15 different antidepressants (not at the same time), 20 sessions of ECT, 5 psychiatrists, and 2 therapists. None of it works!

To make a long story short..about 7 years ago I had random bouts of unexplained fatigue. My general Dr. prescribed Citalapram which seemed to work OK, but never really got rid of the fatigue. From there he recommended a Psychiatrist who in turn started the whirlwind of trial and error meds. Which landed me in the mental hospital. Another Psychiatrist, 20 ECT treatments and more trial and error meds has resulted in no real improvement.

I am now taking my psychiatry into my hands because I know enough now to do trial and error experiments on my own.

I have a lot of information to share, but would like to know first if there are others out there who are in a similar situation and willing to share.