Sunday, March 19, 2006

Days of whine and neuroses

Can't remember if I've used that title before.

Okay, more of this writing rather than panicking thing. I find this a decent way of dealing with stuff.

So far, so okay. The medications have helped the sleep, and I'm not unmanageably dopey at the moment. I did put sugar in Sarah's tea this morning, which is understandable given that she's had the same "milk and none" recipe for only ten or so years. I've started looking at the bills I had forgotten to open. And yesterday I scrubbed the kitchen clean, which was partially necessary because I had come home the day before, found some flies had found their way into the kitchen and sprayed the room liberally with what turned out to be non-stick canola oil.

Plus with the autonomic side effects of the reboxetine I can now strike matches on my tongue.

Anyway: I got some sleep, some decent sleep, and that's going to help things. And many side effects diminish over time. And apparently tentacles are in this year, anyway.

Valproate, by the way, is a damn fine drug for the more egotistical bipolar patient - three months of valproate induced weight gain and the world really will revolve around you.

Seriously, from what I can work out (which isn't much) the principal method of valproate-induced weight gain is alteration of insulin secretion, which means I have to get back down the gym before I am mistaken for a Goodyear blimp. The quetiapine (anti-psychotic) induced weight gain is apparently treatable with the reboxetine (anti-depressant), which is good. Now all I have to worry about is the hair loss and the admittedly small risk of lactation.

I kid you not. A fair proportion of men on antipsychotics (large doses for long times) lactate.

Well, saves me having to bring a bottle of water to the gym, I suppose. Bleargh.

Anyway. What I always tell my patients is that medications are only part of the solution, and the rest of it is the cognitive "what goes on in your mind" stuff, and the lifestyle stuff. The lifestyle stuff is workable - I am going to go out with my friends this weekend even if I have to be wheeled out, frothing and gibbering in a steel cage. I am going to the gym and judo, unless my mental state deteriorates too badly (and as long as I can bring my lord and master, the duck). I am going to fight my way down to the comic shop, the one place in town where my extreme social withdrawal and low-level affective blunting will not be immediately apparent.

The cognitive stuff, the looking at how you think, that is more difficult. For a start, I am thinking more slowly. It has taken me longer to write this than usual - normally it's just sit down and hammer it out, this is day two or three.

I think the main thing is and will be recognizing the emotions – the deeper swings of depression that last a day or so - as that, as neurochemically induced pathological states and not as reflecting how things truly are.

It is not true that my medical career has been littered with the dying and the dead. Well, sometimes it has, but they were dying when they came in.

It is not true, for example, that my wife is going to leave me when she finds out the horrible truth about me. Even if I feel it.

It is also not true, I feel, that my funeral would be attended only by a whiskey priest, a passing tinker and a few disgruntled foes who had turned out to make sure I was dead. And a man wearing a red dress, who had sworn that as soon as I was buried he would dance on my grave in a red dress.

It is unlikely that even now, my erstwhile fellow workers have gathered in secret caverns underneath the hospital, each one robed and masked, and silently shuffle past a hanged effigy on which a crude likeness of my face has been painted, and as each approaches she or he stabs at the effigy and vows “John must die!!!!”

Even drug-free I could see that that last one is quite unlikely. You can’t get the buggers to meet down the pub, let alone elsewhere. And I reckon the nearest caverns are a thousand kays from here.

And so on. Every feeling of despair, every realization of of failure, every cold conviction that the world would be a better place without me. Every tree, every truck, every train track. Check everything.

Weirdly enough, that was my confirmation verse: First Thessalonians, chapter five verse twenty one: “Test all things, hold fast to that which is true.” Not how I originally envisioned using it.

Anyway, enough levity – back to the whining. But seriously, the drugs (which I won’t be taking forever) and the cognitive stuff and the lifestyle stuff will work. If I was my patient I would assure myself that I was prescribing myself the right medications for me, and and I’m sure my ringing confident tones and screeds of scientific evidence would convince me of how right I was, and how foolish I was to doubt me.

Seriously for a moment, I loathe this feeling and I loathe the selfishness and childishness and self-indulgence that goes with it. I hate hearing myself whine and I hate lying at home achieving fuck all and I hate not being able to think straight or fulfill my responsibilities.

I will do anything to get my brain back. If I am prescribed a diet of broken glass and nutella and was convinced it’d make me better, I’d eat it. And I really hate nutella.

Sorry about all this. Normal serotonin/dopamine/noradrenaline levels will resume soon.



Blogger Benedict 16th said...

My Grandmother always said we were Tinkers!
But I don't own a red dress?

Hey the canola oil can kill, well cause emphysema if you breathe it in.
Just takes 20 years thats all...

9:08 PM  
Blogger Foilwoman said...

Benny: I have a red dress I can loan you. With your dark coloring, I'm sure you'll look very fetching while you dance.

BJ: There, there. I've been the mayor of that town. Don't worry, TduCN won't find someone else who will tolerate the cats, either, so I'm pretty sure she's sticking with you. (I'm betting she likes you, also. Just MHO, but there you go.)

3:22 AM  
Anonymous Camilla said...

The world will not be better off without you. I can say this with some authority since I'm finding Europe distinctly lacking in the BJ department, and it's suffering for the lack IMNSHO.

I too have a red dress, but no damn hairy-legged man is getting his grubby, meaty hams on it because I'M going to wear it. When I've lost a few more kilos. And there ain't gonna be no grave dancing neither.

(ps Tournee may not take sugar in her tea, but I know she doesn't object to the occasional packet of M&Ms ;) Mmmm it's been a while since I did that myself...)

ps msg for Tournee - love the kitties in your blog! What beautiful creatures, you must be v. proud :D

4:27 AM  
Blogger Gothqueen said...

Tell me, good Dr, if there is anything that can halt, or reverse the weight inducing effects of Citalopram? I've gained nearly 2 sizes since & started taking it & feel like an overstuffed sausage. I'm aware that i can no longer recognise when I feel full, and indeed, my brain actually translates that feeling into "I'm hungry" Ugh! I fear I'm going to eat myself to death!

9:44 AM  
Blogger Benedict 16th said...

Dear GothQueen,
SSRIs and some others available in Oz in order of antidopaminergic/proadrenergic (decreased appetite stimulation)*
Most appetite stimulating to least (mode of action)
- Avanza (Mirtazepine)** +13 (??)
- Tricyclic antidepressants +10 to +15 (??)
- Luvox (fluvoxamine) +6 (SSRI)
- Aropax/Paxil (Paroxetine) +5 (SSRI)
- Zoloft (Sertraline)*** 0 to +10 (SSRI) (funnilly its the Pfizer info that is closer to 0)
- Citalopram/Escitalopram (Cipramil/Lexapro) 0 (SSRI)
- Prozac/Lovan (Fluoxetine) 0 to -1 (SSRI)
- Efexor (Venlafaxine) -3 (SNRI)
- Edronax (Reboxetine) -3 to -5 (NRI)
- Strattera - Amoxetine**** -5 (NRI)
- Reductil (Sibutramine)***** -6 (SNRI)
- Speed (Methamphetamine) -10 (irreversible reuptake inhibitor)

So everyone's zero point varies (but I am yet to see anyone lose weight on Avanza)
One option is to move down the list, but the dry mouth, sweats and agitation go up.
Another is to mix an SSRI with an NRI.

I haven't included the MAOIs as that is even more complex.

* my guestimation, based on a mix of relative sedative effect and relative dopaminergic effect
** average weight gain 13 kg / yr
*** highly variable
**** For ADHD
***** not marketed as an antidepressant, marketed as a weight loss medication

Hope that helps

10:49 PM  

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