Prescription meds: my A-Z

Every visit to the psychiatrist brings a trip to the pharmacy, and every trip to the pharmacy brings a 20-30 minute wait. I don’t begrudge the time, because the staff are so thorough and always make sure that my drugs are labelled up in such a way that even on a very bad day I can’t get it wrong. If I’ve forgotten to bring a book, or my mind is too fast to concentrate on reading, I find myself l looking at the posters. Most remarkable is the prescription charge notice screwed to the wall next to the counter; every time I visit, I marvel at the fact that it is so ancient that it still refers to the “DHSS”. Someone has printed out that current charges and taped them on the wall, an action that has presumably been carried out every 1^st of April since the 1980s.

Health promotion messages abound. One poster reminds me about the importance of cervical smear tests. Another one points out that “it could be YOU” who has developed mouth or throat cancer, the ideal message for the depressed or paranoid patient. The notice I always end up looking at is a list of all the types of drug for which the Mental Health Trust produces an in-house medicines leaflet. There’s nothing special about the poster itself; it’s just a list of psychiatric drugs, some common, some less well-known. What’s fascinating to me is just how many of those medications I’ve been prescribed over the past 20 years.

Generally speaking, I’m not an anti-medication person. I’m a pragmatist – if it might work, I’ll give it a go. But there’s no doubt that psychotropic drugs come with a whole host of “interesting” side-effects and emotional baggage. Here follows a personal A-Z of psychotropic drugs – the good, the bad and the downright scary.

A is for antidepressants. SSRIs, SRNIs, tricyclics, MOAIs; I’ve tried them all, some for as little as two weeks, one for 8 years continuously. It’s thought that one in three women has taken an antidepressant at some point; I’ve been popping enough pills for the other two.

http://www.platform51.org/news/Women%27s_use_of_antidepressants_at_crisis_point

B is for blood tests, a regular part of my life since I started taking lithium. I have a secret rating system for those taking my blood. What I’m looking for is this: minimal pain (should be easy enough, I have great veins – the blood’s nearly leaping spontaneously into the Vacutainer); some basic knowledge of what my blood test is for, based on my records which are RIGHT IN FRONT OF YOU; and the smallest possible amount of well-meaning advice about how your friend or your sister manages their bipolar with no drugs at all. Apparently it’s very difficult to find someone who hits all the bases.

C is for constipation. Sorry to be so coarse, but since I started my current antipsychotic medication, my entire digestive systems has slowed r-i-g-h-t down. Doesn’t matter how much water I drink or how many prunes I eat; my intestines are as sedated as the rest of me.

D is for “discontinuation syndrome”. Most doctors and drug companies don’t like to hear the unpleasant symptoms caused by stopping SSRI or SNRI antidepressants referred to as “withdrawal”. Withdrawal gets a bad press, being too closely associated with addiction to illegal drugs; discontinuation syndrome sounds nice and clinical, an unavoidable inconvenience. Well, I’ve worked with illegal drug users who are late picking up their methadone, and I know withdrawal when I see it. When I stopped Effexor suddenly (on medical advice), I spent a week in bed struggling to cope restless legs, shooting “electric shock” type pains in my limbs, sleeplessness, sweating, and an upset stomach. Without a doubt, one of the hardest times of my life.

E is for elation, the key symptom of my bipolar that makes me consider not taking medication. Usually I follow medical advice and prescriptions to the letter (see O), but when I’m experiencing a high, filled with feelings of joy, wonder and energy, it seems perverse to take something to bring me down. Intellectually I know that it’s part of my illness, and needs to be stopped before it turns into a more destructive mania or flips to a deep depression, but I don’t want to let the elation go.

F is for fluoxetine (aka Prozac), the first antidepressant I was ever prescribed age 20. I don’t remember much about the visit to the psychiatrist which led to the prescription, other than that I didn’t feel that he was listening to what I had to say at all, and that he told me, “if you are bipolar, these will send you as a high as a kite.” This approach led to a couple of weeks of highly agitated suicidal impulses and put me off taking antidepressants for many years.

G is for GP prescribing. Most people will naturally go to their GP as their first port of call when they are experiencing mental distress. GPs have a good level of familiarity with first line treatments (see S is for SSRIs) but are of course less familiar with more specialist medicines that would normally be prescribed by a psychiatrist. One of my biggest medication mistakes was continuing working through one GP-prescribed antidepressant after another for a period of 18 months of depression after my second child was born. Once I finally saw a psychiatrist, I was placed on a much more unusual reversible monoamine oxidase inhibitor which worked well for me for over 8 years. With hindsight, asking sooner for a Consultant review of the medication options might have reduced the impact of what was a very difficult episode.

H is for happy pills. How I hate the tendency for the media to use this phrase to describe antidepressants. It’s not just tabloids like the Daily Mail or the Sun; the should-know-better broadsheets (such as the Times, the Guardian and the Independent) and the BBC have been known to do it too. What’s particularly unpleasant about it is the snide implication that those of us who take antidepressants are after something more than the “stiff upper lip” coping of the article writers. Surviving is not good enough for us, oh no, we demand to be happy. If the headlines are going to be glib, they should at least be truthful: “Use of non-kill-yourself pills doubles”, “Doctors push day-without-weeping pills on unsuspecting public.”

I is for iatrogenic (“doctor induced”) health problems. Many psychiatric drugs have significant side-effects, some of them irreversible. Continued treatment is a balance between the therapeutic benefit of the medication, and the potential harm it can cause. In the case of lithium, which I am taking now, long term kidney and thyroid damage can result from the treatment. This has to be weighed up, however, against the damage done to my life by the condition itself.

J is for “jellies”, as everyone referred to the benzodiazepine temazapam when I was at university. Based on little more than Black Grape’s song Temazi Party, my friends and I had high hopes for the drug’s effects and were disappointed when I took one and promptly fell asleep.

K is for kilos. Noticeable weight gain is a joyous side-effect of many psychiatric meds, including both the drugs I take at the moment. What could be better than being depressed and fat?

L is for lithium, the newest addition to my list of medications. It’s been a big decision for me to try it, as I described in a recent blog post, but I’m trying to approach treatment with as open a mind as possible. There’s no doubt however that the possibility of toxicity and organ damage is something to take very seriously.

M is for marketing. I would love to know who comes up with both the generic and the brand names for psychiatric drugs. I imagine all these marketing guys sitting in a room somewhere, kicking ideas around. “How about – no, wait a minute, it doesn’t have a Q, a V, an Z or an X in it. Get the Scrabble tiles out.” I particularly like the brand names which allude to desirable outcomes: need to overcome your difficulties? Take Surmontil! Feeling wobbly? Choose Stablon! Lack joie de vivre? Ask your doctor about Vivactil today! On the other hand, I can’t believe that a pharma company actually paid someone to come up with Depressin, Ambivalon, and Dumyrox.

N is for nausea. Open any patient information leaflet for any mental health drug, and I guarantee you nausea will be listed as possible side-effect. The worst I ever had was starting venlafaxine (Effexor), when for the first couple of weeks I had to keep lying down as I was battered waves of what felt like sea-sickness. On the upside, I was too busy feeling physically awful to be anxious or depressed about anything else. Right now the lithium seems to be making a play for the number two slot in the Nauseating Medicines Hall of Fame.

O is for obedience. I’m what the health professionals call a compliant patient; I take what I’m told to take, when I’m told to take it, and I don’t stop unless there’s a treatment plan to get me off it again. I think there are several reasons for this. I’ve previously worked in a clinical NHS role, and I do have a lot of faith in the medical model (so long as it’s combined with self-help measures; I don’t expect to take a magic pill and be instantly well). Also, it seems the responsible thing to do, for my family and my employers, as well as myself. Finally, the side effects and “discontinuation effects” can be scary enough when taking/stopping medication as instructed. I’m just too chicken to ditch it and go it alone.

P is for propranolol, the first ever mental-health related medication I was ever prescribed, at about age 16. The GP didn’t tell me what type of drug it was, but I found out from a nurse acquaintance that it was a beta blocker. Usually prescribed for heart and blood pressure problems, beta blockers are sometimes also used to treat anxiety. Unfortunately, I was clinically depressed rather than anxious, something my GP at the time seemed determined not to acknowledge.

Q is for quetiapine, an atypical antipsychotic I was prescribed in the spring to try and stabilise my bipolar mood swings.  It hasn’t controlled my moods as well as my Consultant and I had hoped; its main effect is to knock me out into a heavy sleep from about 10pm to 9am. I am a scintillating party guest.

R is for reminder. Despite taking one medication or another every day for the past 11 years, apparently I am apparently incapable of remembering to take my tablets without a reminder in my phone (unconscious denial?).

S is for SSRIs, the most often prescribed form of antidepressant. Fluoxetine, paroxetine, sertraline, citalopram or another selective seratonin reuptake inhibitor (SSRI) are often the first line drug treatment offered by GPs. My own experience is that each one I tried worked for a while, and then became less effective. My doctors have always told me that can’t happen, but hey, I was the one who took three different SSRIs in a year.

T is for tricyclics, these days a less commonly prescribed class of antidepressant. My only experience of them occurred when I was acutely depressed and struggling to manage at home with two very young children. Unfortunately, the trazodone I was prescribed made me feel incredibly spaced out and unable to focus (a well-documented side effect), which seemed actively dangerous when trying to care for a baby and a toddler. I fairly quickly switched to another drug.

U is for uncertainty. Every time I am prescribed a new medication, there is a period of uncertainty. Will it work for me? Will I experience side effects, and if I do, will they be transient or long-lasting, trivial or serious? It can be very dispiriting to find after a few weeks or months of living thorough the uncertainty that the drug isn’t doing what was hoped, and to have to begin the whole process again with something new.

V is for velociraptor. Just checking if you’re still paying attention this far into the alphabet. Actually V is for Valium. Benzodiazepines have a bad rep, and there’s no doubt that they have been overprescribed and left some people struggling with pernicious addiction problems. But a short course of benzos has helped me out more than once, particularly when transitioning from one long-term medication or another.

W is for wine, something that’s becoming a distant memory for me. I had no difficulties drinking alcohol with my long-term antidepressant, but starting very sedating antipsychotics has made drinking alcohol nearly impossible. Combine that with the need to avoid dehydration to prevent lithium toxicity, and alcohol has become a real no-go. Like I said, fantastic at parties.

X is for X-ray. A chest X-ray was one the battery of tests I was told I had to undergo before starting lithium therapy in 1995. The whole package of tests was scary, and put me off taking it for a very long time.

Y is for a year. Two of these = the minimum amount of time recommended to continue with drug treatment for bipolar after an acute episode, according to NICE. That’s a lot of lithium to swallow.

Z is for zopiclone. Anyone who’s ever complained about insomnia to their doctor will have been offered “something to help you sleep” at some time, and zopiclone is one of the most frequently prescribed – almost four and a half million prescriptions were written out for it in 2007. I’m not terribly keen on sleeping pills; even after a short period of use, I get to worrying that I can’t do without them.

Now, let me go back to that list in pharmacy, and see what’s still to tick off…