Chapter 35: FEELING SOME RELIEF! Antidepressant Medications

It has been 9 months since I went to the Amen Clinic in Newport Beach, California.  It has taken this long to make all of the medication changes recommended by my doctor at the clinic.  I am starting to feel better, FEELING SOME RELIEF!  I have an atypical depression that needed to be treated in layers.  The anxiety symptoms needed to be treated first, and I talk more about this in Chapter 9 of my blog.  There is a detailed treatment plan from the Amen Clinic in Chapter 10.

I am now taking 150 mg of Effexor XR in the morning with breakfast.  I have come down from 300 mg because I was not feeling any improvement of depression symptoms, and side effects were not going away.  The higher dose was causing insomnia and anxiety, flushing several times a day, and constipation.  These are the only side effects I have experienced with Effexor XR, and they are just about gone on 150 mg.

 




 

I am also taking generic Luvox, fluvoxamine.  I take 50 mg in the morning and 50 mg in the afternoon.  I was already on this drug when I went to the Amen Clinic and my brain scans showed it was helping to quiet the activity in the deep limbic system; but it was not completely effective.  Depression symptoms originate in the deep limbic system.  I am using fluvoxamine for depression, and I do not have any side effects strong enough to notice.  I have been on fluvoxamine for over a year, and a pharmacist told me the brand Luvox is no longer made. The extended-release capsule is a new medication.

Information on generic Luvox, fluvoxamine from:  PubMed Health - Fluvoxamine

 

Why is this medication prescribed?

Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs).

 

How should this medicine be used?

Fluvoxamine comes as a tablet and an extended-release capsule to take by mouth. The tablet is usually taken either once daily at bedtime or twice daily, once in the morning and once at bedtime. The extended-release capsule is usually taken, with or without food , once daily at bedtime. Swallow the extended-release capsules whole; do not crush or chew them.

Your doctor may start you on a low dose of fluvoxamine and gradually increase your dose, not more often than once every week, depending on how well the medication works for you and the side effects you experience.  It may take several weeks or longer for you to feel the full benefit of fluvoxamine. Continue to take fluvoxamine even if you feel well. Do not stop taking fluvoxamine without talking to your doctor.

If you suddenly stop taking fluvoxamine, you may experience withdrawal symptoms such as irritability; agitation; dizziness; extreme worry; uneasiness; confusion; headache; tiredness; mood changes; difficulty falling asleep or staying asleep; or pain, burning, numbness, tingling or 'electric shock' sensations in the hands or feet. Your doctor will probably decrease your dose gradually.

 

Other uses for this medicine

*Fluvoxamine is also sometimes used to treat depression. Talk with your doctor about the possible risks of using this medication for your condition.  This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

 

What side effects can this medication cause?

Fluvoxamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, difficulty concentrating, dry mouth, headache, nausea, vomiting, diarrhea, stomach pain, constipation, indigestion, gas, change in taste, decreased appetite, weight loss, nervousness, weakness, unsteadiness, and changes in sex drive or ability.

I am taking generic Neurontin, gabapentin, to help calm the activity in the basal ganglia where anxiety begins.  I take a 300 mg capsule four times a day,1,200 mg total.  Neurontin is an anticonvulsant medication the Amen Clinic has found to be effective for anxiety.  I started on this drug as soon as I got home from the clinic to help me get off the drug clonazepam.  I have written quite a bit about clonazepam in Chapter 12 - I Hate Clonazepam and Chapter 15 - Clonazepam The Beast.  (I have been off The Beast for 7 months! =)  My doctor at the clinic chose gabapentin for me because of its low side effect profile, but you will see there are many side effects listed for this drug in the following article.  I did not experience any of these side effects.

Information on generic Neurontin, gabapentin from: PubMed Health - Gabapentin

 

Why is this medication prescribed?

Gabapentin is used to help control certain types of seizures in patients who have epilepsy. Gabapentin is also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain.

 

How should this medicine be used?

Gabapentin comes as a capsule, a tablet, and an oral solution (liquid) to take by mouth. It is usually taken with a full glass of water (8 ounces [240 milliliters]) three times a day. Gabapentin may be taken with or without food. Take this medication at evenly spaced times throughout the day and night; do not let more than 12 hours pass between doses.

If your doctor tells you to take one-half of a tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly throw away any half-tablets that you have not used within several days of breaking them.

Your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.

 

Other uses for this medicine

Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (''change of life'', the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.  This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

   

What side effects can this medication cause?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, tiredness or weakness, dizziness, headache, shaking of a part of your body you cannot control, double or blurred vision, unsteadiness, anxiety, memory problems, strange or unusual thoughts, unwanted eye movements, nausea, vomiting, heartburn, diarrhea, dry mouth, constipation, weight gain, swelling of the hands, feet, ankles, or lower legs, back or joint pain, fever, runny nose, sneezing, cough, sore throat, or flu-like symptoms, ear pain, and red, itchy eyes.

My favorite website to learn about medications is Crazy Meds! The Good, The Bad, and The Funny.  It will tell you about uses, pros and cons, effects, side effects, and stuff your doctor usually won't tell you.  "Crazy Meds Suck Donkey Dong"  If that quote is offensive to you, you may not like this site.

I hope you are FEELING SOME RELIEF from your antidepressant medication, or will be soon!!

Chapter 30: Don't Stop Believing

This made me feel good this week!

"Steve Perry and 43,000 Friends NEVER 'Stop Believing' in the Giants - NLCS Game 5" 

You may remember the rock band Journey.  They were playing one of their songs, "Don't Stop Believin'", during the Giants National League Championship Series, Game 5 on 10/21/10.  One of the cameras caught Steve Perry, lead singer, standing up in the crowd singing his own song.  Awesome!

"Gotta love Steve Perry leading a packed house @ AT&T Park, San Francisco"

  


Steve Perry and Journey Performing "Don't Stop Believin'" In Concert
(I'm trying to find out where and when.)

This song, first featured on Journey's Escape album, was written by 

Jonathan Cain, Steve Perry, and Neal Schon; all members of Journey.

Don't Stop Believin'
- Journey
1981

Just a small town girl
Living in a lonely world
She took the midnight train going anywhere
Just a city boy
Born and raised in South Detroit
He took the midnight train going anywhere

A singer in a smoky room
A smell of wine and cheap perfume
For a smile they can share the night
It goes on and on and on and on

{Refrain}
Strangers, waiting, up and down the boulevard
Their shadows searching in the night
Streetlight people, living just to find emotion
Hiding somewhere in the night

Working hard to get my fill
Everybody wants a thrill
Paying anything to roll the dice
Just one more time
Some will win, some will lose
Some were born to sing the blues
Oh the movie never ends
It goes on and on and on and on

{Refrain}

Don't stop believing
Hold on to that feeling
Streetlight people

Popularity:
The song reached #8 on Billboard's Mainstream Rock chart, and #9 on the Billboard Hot 100 chart. It also peaked at #62 on the UK singles chart. The song also has appeared in a number of film and television series, including The Wedding Singer, Monster, Shrek The Halls, The Comebacks and Scrubs.

Journey
Journey live in Minneapolis, Minnesota on September 16, 2008.
Background information
Origin	San Francisco, California
Genres	Rock, hard rock, pop rock, progressive rock, jazz-fusion, AOR
Years active	1973–1987; 1995–present
Labels	Columbia, Frontiers, Sanctuary
Associated acts	Santana, The Babys, Steve Perry, Hardline, Bad English, The Storm, Vital Information, The Zoo
Website	JourneyMusic.com
Members
Neal Schon Ross Valory Jonathan Cain Deen Castronovo Arnel Pineda

http://en.wikipedia.org/wiki/Journey_%28band%29

Update on my treatment plan from the Amen Clinic:

After being on 300 mg of Effexor XR for 5 weeks a new side effect started, insomnia.  In the past, the side effects would start 3-4 days after raising the dose.  After a week of not sleeping well I was exhausted.  There had not been any other changes in my life that would have caused lack of sleep, so I lowered the dose of Effexor XR to 262.5 mg.  

I talked to my psychiatrist here at home and got his guidance on this decision.  This is the plan we decided on.  I stayed on 262.5 mg for 4 days and still could not sleep, so I lowered the dose to 225 mg.  Gradually, I started to sleep again and about 4 days later I was sleeping well.  The depression symptoms have not increased, but they have not decreased as I have been hoping and waiting for.

I have not been able to lower the dose of Luvox below 50 mg per day.  If I did, the depression symptoms became worse.  So I have increased the dose of Luvox to 75 mg a day, 25 mg in the morning, 25 mg in the afternoon, and 25 mg in the evening.  I will increase the dose to 100 mg a day if the depression symptoms do not improve.

So now I am taking 300 mg of Neurontin 4 times a day, 225 mg of Effexor XR once in the morning, 75 mg of Luvox 3 times a day, and the supplements and vitamins/minerals I have been taking for many months.  There are some days I feel good, but it does not stay consistent.  I am hoping all of the things I have been doing to heal are going to come together and work, soon!

DON'T STOP BELIEVING

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

 

Chapter 23: Angry At The Disease

I am angry at the disease depression and I need to put the reasons why in writing.

I am tired of:

having withdrawal symptoms from every psychiatric medication I have stopped taking.

having side effects from every psychiatric medication I have started.

having to wait 4-8 weeks to see if a medication is going to be effective.

needing medications that are expensive.

having a psychiatrist who tried 15 different drug combinations in a year and a half with few results; and then didn't support me after I went to the Amen Clinic for help.

"traditional psychiatrists" using an educated guess in determining which medication would be effective for me.  They decided after hearing my list of symptoms.  Other medical fields look at the organ they are treating.

letting things I need to do just sit. 

having everything I do take so much effort.

having to put my life on hold because I don't feel like doing anything. 

having thoughts that come from a brain not functioning correctly, not from anything real.

having things that were important to me lose their value. 

not having any energy. 

not finding pleasure doing things I used to enjoy.

not feeling well enough to attend activities.

my body not creating enough neurotransmitters on its own.

people I love having to deal with this disease.

having a genetic predisposition for depression.

not having advanced medical care in the treatment of depression where I live.  I needed to go to another state.

families and friends losing someone they love because of suicide.

depression causing extreme misery.

available technology not being used with every patient it could help.  SPECT Brain Scans and the research that goes with them gives a psychiatrist more information to diagnose and treat psychiatric disorders.  The Amen Clinics have been using this technology for about 10 years.

Information from, The UltraMind Solution, by Mark Hyman, M.D.

Taken from pages 11 and 12; book published in 2009

• Psychiatric disorders affect 26 percent of our adult population or more than 60 million Americans.
• More than 20 percent of children have some type of psychiatric disorder.
• More than 40 million people have anxiety.
• More than 20 million people have depression.
• One in ten Americans takes an antidepressant.
• The use of antidepressants has tripled in the last decade.
• In 2006, expenditures on antidepressants soared to over $1.9 billion.
• Psychiatric disorders like depression and anxiety are expensive.  They are among the top five most costly medical conditions, including heart disease, cancer, trauma, and lung disorders.  The cost to our health-care system exceeds $200 billion a year, which is over 12 percent of total health-care spending.
• Alzheimer's disease will affect 30 percent (and some experts say 50 percent) of people over eighty-five years old, which is the fastest-growing segment of the population.  It will affect 16 million people by 2050.
• Attention deficit hyperactivity disorder is a label we now give 8.7 percent of children between the ages of eight and fifteen.
• More than 8 million, or one in ten, children now take stimulant medications like methylphenidate (Ritalin).
• Autism rates have increased from 3 in 10,000 children to 1 in 166 children--an elevenfold  increase--over the last decade.
• Learning disabilities affect between 5 and 10 percent of school-age children.
• The indirect costs of all these broken brains to society are mammoth.  They include loss of productivity at school, home, or in the workplace, accounting for a loss of over $80 billion a year. 

Thanks for reading.  My heart goes out to everyone who is angry and tired of depression!

Chapter 18: "Fulfillment, Peace, Life in all its Fullness."

Sixteen days on Effexor XR, seven of them on the higher dose of 75 mg in the morning.  I decided to not lower Luvox quite so quickly.  I am taking 25 mg in the morning and 37.5 mg in the afternoon.  In three more days I will increase Effexor XR to 112.5 mg and lower Luvox to 25 mg on both doses.  I have had short periods of time where I feel the depression symptoms are lifting.  I am still not feeling side effects or withdrawal, which is a huge positive!

I am still hopeful.  I am trying to take life a day at a time.  Prayer and faith in my Higher Power to give me direction are sustaining me.  Listening to Eckhart Tolle every day helps me stay focused on the Now, not spending much time in the past or making up a possible future.  Chapter 8 in, The Power of Now, A Guide to Spiritual Enlightenment, Tolle explains what he believes salvation is.  

"True salvation is fulfillment, peace, life in all its fullness.  It is to be who you are, to feel within you the good that has no opposite, the joy of Being that depends on nothing outside itself.  It is felt not as a passing experience but as an abiding presence.  In theistic language, it is to 'know God' --- not as something outside you but as your own innermost essence.  (I believe this is my spirit, which Tolle calls the inner being.  I believe my spirit is a literal offspring of my Higher Power.)  True salvation is to know yourself as an inseparable part of the timeless and formless One Life from which all that exists derives its being.

True salvation is a state of freedom --- from fear, from suffering, from a perceived state of lack and insufficiency and therefore from all wanting, needing, grasping, and clinging.  It is freedom from compulsive thinking, from negativity, and above all from past and future as a psychological need.  Your mind is telling you that you cannot get there from here.  Something needs to happen, or you need to become this or that before you can be free and fulfilled.  It is saying, in fact, that you need time --- that you need to find, sort out, do, achieve, acquire, become, or understand something before you can be free or complete.  

You see time as the means to salvation, whereas in truth it is the greatest obstacle to salvation.  You think that you can't get there from where and who you are at this moment because you are not yet complete or good enough, but the truth is that here and now is the only point from where you can get there.  You 'get' there by realizing that you are there already.  You find God the moment you realize that you don't need to seek God.  So there is no only way to salvation:  Any condition can be used, but no particular condition is needed.  However, there is only one point of access: the Now.  There can be no salvation away from this moment.

There is nothing you can ever do or attain that will get you closer to salvation than it is at this moment.  This may be hard to grasp for a mind accustomed to thinking that everything worthwhile is in the future.  Nor can anything that you ever did or that was done to you in the past prevent you from saying yes to what is and taking your attention deeply into the Now.  You cannot do this in the future.  You do it now or not at all."

Fulfillment, peace, life in all its fullness ... a state of freedom --- from fear, from suffering, from a perceived state of lack and insufficiency, wanting, needing, grasping, and clinging ... freedom from compulsive thinking, from negativity, and above all from past and future as a psychological need.  This is what I want.  I am getting better at Living in the Now everyday.

Chapter 17: Effexor XR, ADHD & Viral Meningitis

I have been on 37.5 mg of Effexor XR for 9 days and I feel the same.  This is a good thing!  I have not felt any side effects or withdrawal symptoms from lowering the dose of Luvox.  (Or at least not enough to notice.)  I will go up to 75 mg of Effexor XR tomorrow morning, and lower the dose of Luvox to 25 mg in the morning and 25 mg in the afternoon.  I am hopeful!

I think it was my last post I mentioned the new psychiatrist in my city that supports my trip to the Amen Clinic.  I think I told you how AWESOME he is.  :)  He discussed an interesting possibility with me.  I was diagnosed with ADHD from the results of my brain scans at the Amen Clinic.  I feel I have had ADHD for the past 2 1/2 years, but not my whole life.  My doctor was a teacher and researcher at a university before he recently went into private practice.  The research he was involved with indicated there is usually something that precipitates the onset of ADHD later in someone's life.

He asked me if I had a brain injury, or a major illness such as encephalitis or meningitis.  I said no, but then I said wait a minute, I may have had meningitis.  In February of 2003 I went in to the emergency room on a Friday night with a severe head and neck ache.  They gave me morphine in an IV for the pain and said it could be meningitis, but I didn't seem sick enough to warrant a spinal tap (lumbar puncture).

By Sunday morning the pain in my head and neck was excruciating; I had never felt anything like it before.  I may have passed out more than once as my husband drove me to the hospital.  I was in such bad shape I was admitted immediately into the emergency room, no waiting!  :)  The fluid in the spinal tap was negative for bacterial meningitis.  My white blood count was extremely high, but they couldn't find a specific cause of the infection.  I was given morphine through an IV that whole day and sent home Sunday night.  The possibility of viral meningitis was never mentioned.

The next four days I took a combination of prescription pain killers.  I could barely get out of bed and had no appetite because of nausea.  I could not tolerate any light and had to keep my room dimly lit.  By Wednesday of that week I could no longer tolerate the pain.  The pleading with my Higher Power changed in content from asking for help, to asking if this was the time for me to die.  I had never been so sick and I asked my Higher Power if death was going to be the outcome, "Could we do it now?"  If I had a choice I wanted to stay to finish raising my sons, but if that wasn't part of the plan I was ready to "move on".  I remember feeling surprised at how simple the decision was.

Thursday night as I went to sleep I was planning on asking my husband to admit me to the hospital the next morning. Friday morning I woke up slowly and realized the fever had broken and food sounded good.  I believed recovery was possible and I felt blessed.  Full recovery took another week.  Now I believe I had viral meningitis.  This inflammation in the membranes around my spinal cord and brain may have made me more vulnerable to ADHD.  Interesting!  Here are the symptoms and the differences in meningitis and encephalitis if you would like more information.  

Taken from:

http://www.ehow.com/facts_6186800_difference-between-meningitis-_amp_-encephalitis.html

Difference Between Meningitis & Encephalitis

By Anjus Chiedozie, eHow Contributing Writer

I want to do this! What's This?

Meningitis and encephalitis are two medical conditions that involve inflammation, thus the suffix "itis." Despite their similarities, meningitis and encephalitis are not quite the same.

Description

1. Meningitis is an inflammation of meninges, which are membranes that envelop the nervous system, particularly the brain and spinal cord. Encephalitis is an inflammation of the brain itself.

 

Causes

2. Meningitis usually results from either viral or bacterial infection. Encephalitis is usually caused by viral infection.

 

Symptoms

3. Symptoms of meningitis and encephalitis include high fever, seizures and headache. Additional symptoms of meningitis include stiff neck, vomiting or nausea with the headache, and sensitivity to light. Encephalitis-specific symptoms include hallucinations, tremors and loss of consciousness.

 

Treatment

4. Bacterial meningitis is usually combated with intravenous antibiotics. People infected with viral meningitis or encephalitis usually require substantial fluid intake, over-the-counter pain medications and lots of rest for treatment.

 

Prevention

5. Bacterial meningitis can be prevented by maintaining a healthy lifestyle and avoiding instances that can put you in contact with bacteria. Viral meningitis and encephalitis can be avoided by immunization, and preventative measures include keeping away from major viral agents such as mosquitoes.

Read more: Difference Between Meningitis & Encephalitis | eHow.com http://www.ehow.com/facts_6186800_difference-between-meningitis-_amp_-encephalitis.html#ixzz0u5llOx3N