Wednesday, January 9, 2008

Old stigmas die hard

Last week was the end of the clinical research trial that I started in April for a new-and-improved antidepressant that my doctor affectionately refers to as "the son of Effexor". I believe the brand name is Pristiq (from Wyeth), but I'm not sure. Whatever it is, it worked wonders, both in significantly reducing my depressive symptoms and in improving my sleep (I have sleep apnea, fibromyalgia and chronic insomnia, which my doctors and I believe are the biggest contributing factor to the depression).

Despite the horror stories I've heard and read about Effexor, I didn't have any side effects from the medication, either tapering on, or tapering off. Actually, I take that back - there was one very surprising, and very welcomed side effect that I noticed while I was on the drug - for me, it was a very effective appetite suppressant. During the first 6 weeks at my maintenance dose, I lost 10 lbs and kept it off for the balance of the study (over 6 months). In the past month since I started weaning off of the medication, I've gained back 4 lbs.

Last week I went to see the study doctor last week, who is going to be my private brain doctor now that the study is over. After we discussed how effective the medication had been and how smooth the withdrawal process had been for me, he started to explain how we would taper back onto Effexor XR until the new drug is approved by the FDA, at which point I can switch. Or, alternatively, I suggested that since I was now off and feeling great, that I wanted to stay off for a while just to "see what would happen."

At that point my doctor politely told me that my idea was a terrible one. Bless his heart, he took the time to very thoroughly and patiently explain to me the many reasons why he thought it was important that I continue to take the medication, particularly since it was working. As he was explaining his rationale, I remembered the discussions that I had with the hospital doctors and nurses both before and after my hysterectomy about using the morphine pump. They continually reminded me that it's much easier and more effective to manage pain by taking pain medication before the pain becomes unbearable, than to try to reduce the pain after it's become severe. I am obviously not a medical professional so forgive me for over-simplifying, but even with a headache, I find that it's much easier to ease the pain if I take something at the first signs of an approaching headache rather than trying to tough it out. If I wait too long, it takes much longer, and much more medication, to get rid of the headache once it's taken hold. And if I really wait too long, medication won't work at all and I simply have to go to bed and try to sleep until the headache goes away on it's own.

I know that there are as many perspectives on medications for mental pain as there are people who experience it, but after thinking about my conversation with my doctor for a while, I realized that he was right, and that deep down inside, I knew he was right (at least for me) before I told him that I wanted to stop taking the medication. So why then was this even an issue for me? Because without realizing it, I'd fallen back into the same stigma trap that frustrates me so much when others do it. In my mind, there was something inherently "weak" about resigning myself to a potentially lifelong "maintenance dose" of medication to ease the symptoms of depression and insomnia that I've lived with for years. Rather than being elated that I'd finally found something that works, my natural reaction was to downplay the significance of this blessing.

I have very high cholesterol, and so does practically every woman on my mother's side of the family. I didn't think twice when my doctor reminded me of the long-term health risks of high cholesterol levels and suggested that since diet and exercise weren't doing enough, that I needed to be on cholesterol-lowering medication. Yet when my doctor reminded me of the long-term health risks of depression and insomnia (not to mention the existing symptoms of which I am very well aware), and suggested that since thinking my way through it or pretending that it wasn't a problem weren't doing enough, that I needed to be on an antidepressant, I had difficulty with that. How are the situations different? They aren't. This is why I hate the term "mental illness". In addition to the fact that I simply don't think it applies to me, that term makes it too easy for me and for others to forget that there is no fundamental difference between treating the biochemical imbalances in my brain and treating the imbalances in other bodily organs that cause me to have high cholesterol, low blood sugar or fibromyalgia.

So, today was my last day of no medications, signalling the end-end of the clinical trial. And tomorrow morning, I start taking Effexor again, and finally tomorrow night I'll start taking Lunesta too (I can't wait to see those butterflies). Of course I'm looking forward to losing those pesky 4 lbs again, but more importantly, I'm looking forward to knowing that I'm taking control of my pain management in a way that works for me.

2 comments:

marja said...

I understand how you felt about being prescribed a maintenance dose of antidepressant. At my last visit, my psychiatrist told me that he wants me on a maintenance dose of prozac. I didn't like the thought of that either. Though I'm ok with taking the mood stabilizer and anti-psychotic, there's something about my need for an anti-depressant that makes me feel I'm weak. But, like you, have decided I probably need it.

One thing I worry about is that many doctors will not give antidepressants to bipolar patients because it can push them into mania. I haven't had that problem, perhaps because my other medications are good at managing my tendency to get high.

Syd said...

Thanks, Marja.

Yes, I too was concerned about the issue of antidepressants possibly causing mania and my dr and I discussed this at length. The fact that that hasn't happened in nearly a year seems to suggest (at least for now) that this is not a "pure" case of BP because if it were, it's unlikely that the medication would have been as successful with the depressive symptoms and it probably would have at least caused a hypomanic episode by now. But, we have a plan just in case that happens, and I will be cognizant of my moods and symptoms and be on the look out for any warning signs.