Saturday, September 25, 2010

Chapter 26: Is Mercury Toxicity Causing Depression?

"Mercury, I believe (because of the hundreds of patients I have seen with mercury toxicity), is one of the most serious threats to our brain, and is responsible for or contributes to much of the modern epidemic of autism, ADHD, depression, dementia, and other versions of broken brains.  Finding it and getting rid of it in my patients is one of the most effective ways I have to improve mood, attention, and memory."  Mark Hyman, M.D., The UltraMind Solution, page 72.

Mercury is the second-most toxic substance known to human biology, after plutonium.

"Throughout the centuries, several incidents of mercury toxicity have been reported. Mercury has been found in Egyptian tombs, indicating it was used as early as 1500 BC. In the late 18th century, anti-syphilitic agents contained mercury. It was during the 1800s that the phrase "mad as a hatter" was coined because of the chronic mercury exposure that the felters (hats were made of felt) faced because mercury was used in hat making.  (Think of the "mad hatter" character in, Alice In Wonderland.)

In the 1940s and 1950s, mercury became known as the product that caused acrodynia, also known as pink disease. Manifestations of acrodynia include pain and erythema (abnormal redness of the skin resulting from dilation of blood vessels as in sunburn or inflammation) of the palms and soles, irritability, insomnia, anorexia, diaphoresis (perspiration: the process of the sweat glands of the skin secreting a salty fluid), photophobia (a morbid fear of light), and rash.

Some of the more recent occurrences include exposures in Minamata Bay in Japan (1960) from toxic dumping into the ocean, mercury contaminated fish in Canada (1960), methylmercury treated grain in Iraq (1970) mercury was applied to prevent spoilage of grain used for planting, but the grain was eaten by accident, and in the United States (1996), a beauty cream product from Mexico called "Crèma de Belleza-Manning.

For centuries, mercury was an essential part of many different medicines, such as diuretics, antibacterial agents, antiseptics, and laxatives.  Mercury poisoning is usually misdiagnosed because of the insidious onset, nonspecific signs and symptoms, and lack of knowledge within the medical profession."    
http://emedicine.medscape.com/article/819872-overview

"One thing is absolutely clear though: coming in contact with mercury can be a health risk.  Once having been accumulated in the body, mercury is not easily released and flushed out with regular detoxification as it hides deep within the organs and tissues.

Depression?
Not only does mercury poison affect the brain adversely as in Alzheimer’s disease, as well as affecting the heart, thyroid and immune system, it may also be the cause of emotional and behavioral problems:  Depression, mood swings, irritability, fear, extreme anger, insomnia, ADHD and loss of energy – there is a long list of symptoms of possible mercury poisoning.

Who should be more concerned about mercury poison?
Some groups of people are susceptible to mercury poisoning more than others:
     • Dentists and those who work in dental offices
     • People with silver dental fillings
       (for a directory of dentists providing safe removal of mercury fillings, click here)
     • People who live in the vicinity of coal-fired power plants
     • Workers in environments that use mercury for:  barometers, neon lights, explosives, insecticides, and paint    
     • Film developers
     • People who eat fish grown in fish farms
     • Mirror makers
     • Embalmers
     • Dye and ink makers
     • Jewelers      
     • Cosmetic makers"

Mercury is toxic in low doses as in dental amalgam fillings, vaccines, and environmental exposures.  The largest environmental exposure is from consumption of large fish contaminated with mercury such as tuna, swordfish, shark, tilefish, and sea bass, as well as nearly all river fish.  Large fish eat smaller fish and toxins bio-concentrate up the food chain.  The bigger the fish, the higher dose of mercury you are likely to get.  So eat only fish that are small enough to fit in your frying pan.  (Information taken from, The UltraMind Solution, by Mark Hyman, M.D. pages 72 & 73)

Very interesting article about Abraham Lincoln:

By Melissa Lee Phillips
Neuroscience for Kids Consultant
July 10, 2002

In the years before he became president, Abraham Lincoln exhibited many behaviors inconsistent with his dignified image. According to writings of some of his friends and acquaintances, Lincoln was prone to highly unpredictable moodiness, to fits of extreme rage, and to unexplained bizarre actions. Most of these behaviors stopped soon after his inauguration. Researchers, led by medical historian and retired physician Norbert Hirschhorn, published a report in 2001 hypothesizing that Lincoln suffered from mercury poisoning for years prior to his presidency.

For many years, Lincoln took pills referred to as "blue mass." The main ingredient in blue mass was elemental mercury. In the 1800s, these blue pills were commonly prescribed for a wide variety of conditions, including worms, tuberculosis, toothaches, and cholera. They also were often prescribed for "hypochondriasis," a very general medical term that was used to describe many different physical and mental problems. Lincoln was said to have suffered from one condition often attributed to hypochondriasis: melancholia or depression. It is likely that a physician recommended that Lincoln take these blue pills for his depression.
Physicians in the 1800s did not know that mercury is a powerful neurotoxin. Once ingested, mercury binds to molecules in the central nervous system and can cause behavioral problems. Common symptoms of mercury poisoning are irritability, anxiety, hostility, depression, insomnia, memory loss, nerve damage, tremor, and problems with dexterity. Lincoln apparently suffered many of these symptoms during the time he is believed to have taken mercury pills.

Fortunately, many of the toxic effects of mercury are reversible. If mercury consumption stops, eventually some of the adverse symptoms stop too. A friend of Lincoln's wrote that Lincoln stopped taking blue pills about five months after the presidential inauguration. Lincoln felt that the pills made him "cross." After that, Lincoln's behavior changed: the rage attacks ceased, he remained calm in stressful situations, and the deep melancholy seemed to subside." 

I am wondering if mercury poisoning could be a part of the depression symptoms tormenting me?


Friday, September 17, 2010

Chapter 25: Effexor XR, $260.59 or $160.80 Every Month

If you take the drug Effexor XR and you do not have medical insurance to help pay for the medication, this will be the cost.  These prices are taken from the pharmacy at Costco.com.  

Name                                                                       Quantity (number of capsules)
(manufacturer)                                                            30                60                90

VENLAFAXINE HCL ER 37.5 MG                            $121.69       $234.14       $344.48
CAP (TEVA) Generic Alternative

EFFEXOR XR 37.5 MG                                           $133.40       $261.50       $389.61

VENLAFAXINE HCL ER 75 MG                               $131.98        $258.88      $385.47 
CAP (TEVA) Generic Alternative

EFFEXOR XR 75 MG                                              $145.41       $238.18       $474.00
CAPSULE (WYETH)

VENLAFAXINE HCL ER 150 MG                             $139.86        $274.52       $410.70
CAP (TEVA) Generic Alternative

EFFEXOR XR 150 MG                                             $156.82        $260.59       $525.79
CAPSULE (WYETH)

My medical insurance has a $5,000.00 deductible, does not have a copay, and gives us a small discount on prescription drugs.  To help save money I buy my Effexor XR from Canada Pharmacy at http://www.canadapharmacy.com.  These are the prices of Effexor XR from Canada Pharmacy.

Generic 37.5 mg       90 capsules       $20.00 

Brand 37.5 mg          28 capsules       $45.00
Brand 37.5 mg          84 capsules       $125.00

Generic 75 mg          30 capsules       $45.00
Generic 75 mg          90 capsules       $120.00

Brand 75 mg             28 capsules        $60.00
Brand 75 mg             84 capsules        $147.00

Generic 150 mg        90 capsules       $86.00

Brand 150 mg           28 capsules        $80.00
Brand 150 mg           84 capsules        $225.00

I will be increasing the dose of Effexor XR from 262 mg to 300 mg next Tuesday morning.  I want to figure out the difference in price from Costco Pharmacy and Canada Pharmacy.  My doctor has recommended I stay on 300 mg for 8-12 weeks before we decide to increase the dose again.

Costco:  60 capsules would be a 30 day supply so the cost would be $260.59
60 capsules for $260.59 are $4.34 per pill
90 capsules for $525.79 are $5.84 per pill

Canada Pharmacy:  It would be less expensive to buy 84, 150 mg capsules for $225.00.  Each pill is approximately $2.68 each:  $2.68 X 60=$160.80
28, 150 mg capsules would be $2.86 per pill

So I will save about $100.00 buying Effexor XR from Canada Pharmacy, but it is still expensive to be on a drug that is $160.80 every month.  It will be even more expensive if I need to raise the dose.  When I purchase my medication I miss the years we had a small copay for prescription drugs, but I don't miss the high premiums we paid for medical/pharmacy coverage for our small business.

To get started on Effexor XR I bought 21, 37.5 capsules from a prescription at Walgreen's pharmacy.  Retail price was $111.69, my medical insurance gave me a $22.17 discount, so the cost was $89.52.  Retail price for one pill is $5.32.  The discounted price for one pill is $4.26.

I needed more 37.5 capsules so I bought 40 from the prescription at Walgreen's.  Retail price was $209.29, my medical insurance discount was $41.94, so the final cost was $167.35.  This time retail price for one pill was $5.23, and the discounted price was $4.18.

The following editorial discusses the "indirect" costs of mental disorders.  I thought it was interesting.  If you would like to read the whole article go to:
http://ajp.psychiatryonline.org/cgi/content/full/165/6/66 

Editorial 
Assessing the Economic Costs of Serious Mental Illness 
Thomas R. Insel, M.D.

"What do mental disorders cost the nation? The costs of health care are considered one of the greatest challenges in U.S. public policy (2). In 2006, health care costs reached 16% of the nation’s gross domestic product, on a path to reach 20% by 2016 (3). While mental disorders contribute to these costs at an estimated 6.2% of the nation’s spending on health care (4), the full economic costs of mental disorders are not captured by an analysis of health care costs. Unlike other medical disorders, the costs of mental disorders are more "indirect" than "direct." The costs of care (e.g., medication, clinic visits, or hospitalization) are direct costs. Indirect costs are incurred through reduced labor supply, public income support payments, reduced educational attainment, and costs associated with other consequences such as incarceration or homelessness. Another kind of indirect cost results from the high rate of medical complications associated with serious mental illness, leading to high rates of emergency room care, high prevalence of pulmonary disease (persons with serious mental illness smoke 44% of all cigarettes in the United States), and early mortality (a loss of 13 to 32 years) (5). While indirect costs have been challenging to quantify, they are critical for informing public policy. Once we assess the key components of the economic burden of mental disorders, we can have a more informed discussion about what should be invested to prevent and treat these illnesses."

Am J Psychiatry 165:663-665, June 2008
doi: 10.1176/appi.ajp.2008.08030366

Thursday, September 9, 2010

Chapter 24: Effexor XR, Please "Kick In" Soon

It felt good to vent in Chapter 23! :)


Effexor XR Catchup:  I did not feel any side effects from Effexor XR until I started on 150 mg.  I had a mild headache and constipation.  These are frequent side effects with this medication.  After 10 days the side effects diminished quite a bit, so I raised the dose to 187.5 mg.  I was relieved the side effects did not flare up again and my depression symptoms improved a little bit.  

Ten days later I raised the dose to 225 mg.  On this dosage I have noticed my appetite isn't as good.  I am not nauseated, but food doesn't sound or taste good.  It will be interesting to see if this side effect decreases in the next week to 10 days.  I have not been able to lower my dose of Luvox to less than 25 mg in the morning and 25 mg in the afternoon.  If I do, the depression symptoms become worse.

It has now been 9 days since I increased the dose of Effexor XR to 225 mg.  My lack of appetite has improved as well as the headaches and constipation.  I will probably wait to raise the dose to 262.5 mg until next Tuesday, which will be two weeks.  The improvement in the depression symptoms is subtle.  It has been a long wait!  I am hoping for a big improvement soon.

I have been reflecting on the past 29 years of dealing with the disease of depression.  I am going to talk about random memories I have.  If anyone would like to share their memories, opinions, or experiences about psychiatric diseases, please comment on my blog.  I would like to read your comments.

During the 1980's I was seeing a psychiatrist who had a psychologist working with him.  The psychologist met with support groups on different subjects.  For those of you who have never gone to a psychiatrist, you do not lie on a couch and talk about your dreams, hopes and desires.  (Like in some movies or shows.)  I have always sat in a chair and focused on my symptoms and what medications may be effective.  My life situation was discussed, but not in detail.  I have talked about my life situation in detail with a psychologist and a therapist.  It can be very helpful.  The psychiatrist I started going to in the 1980's was my doctor until he retired in 2009.  He had known me for so long I think he did know my life situation in great detail! 

I decided to join a depression support group led by the psychologist mentioned above.  The first night we met there were several of us sitting in the room waiting for the psychologist.  A man came to the doorway and said, "I'm not sure I am in the right place.  What group is this?"  The man sitting across from me said, "This is the depression support group."  The man in the doorway said, "Oh, thanks", and walked away.  "He doesn't want to be associated with the likes of us.  I can't say that I blame him."  This was said as a joke by the man who told him which group it was, and we were all laughing as the psychologist came into the room to begin the meeting.

I hope the prejudice against people with psychiatric diseases has improved since the 1980's.  When I was first diagnosed with depression in 1983 there were no ads on television about depression or the medications used to treat it.  There is more media attention in 2010, but I don't know if people are being educated about the fact that psychiatric disorders are diseases caused by areas of the brain not functioning correctly.  They are not a character flaw, or something you can just snap out of.  They are brain diseases that can be severely debilitating! 

A lot of people don't realize that depression is an illness. I don't wish it on anyone, but if they would know how it feels, I swear they would think twice before they just shrug it. 
Jonathan Davis 

Depression is a treatable medical illness like cancer and heart disease. – Judith Peacock 

For me being depressed means you can spend all day in bed, and still not get a good night’s rest. – Unknown 

That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key. – Elizabeth Wurtzel

Depression is a prison where you are both the suffering prisoner and the cruel jailer.  -- Dorothy Rowe 

"We don't see things as they are, we see them as we are." — Anaïs Nin