I’m due to see you next week, but I’ll be in Sydney on that day so I guess I won’t see you until the appointment in October.
I think we need to look at a different drug regimen – perhaps the Efexor is losing its efficacy with me. I certainly feel like I’m unravelling at a faster and faster rate.
Just today I have deliberately and successfully over-priced my services on a quote in order to not get the work. Normally I would have jumped at the chance to earn $15-20k for a month or so of work, but I can’t even complete the simple tasks I have at the moment, let alone entertain the prospect of taking on more responsibilities.
The escapist fantasies still loom large in my thoughts and I wonder if I am bringing them to fruition with my own behaviour – all I want to do is expire, to have my light extinguish itself peacefully; to suffer a cardiac arrest from which I do not recover, an infection from a superbug from which there is no cure.
I feel like I am sliding down an ever-increasing spiral, the speed picking up and the wind blowing in my hair as I dissemble, deteriorate and hopefully die.
Naturally, being the skilled showman I am, I can smile and laugh and cause merriment in others. But each day finds me sadder and sadder, each night a torture as I smile for my wife and try not to scare her.
As a pop song in the mid-late 1990s had it, “the drugs don’t work.” Not at the moment, at any rate.
Comparing mood-stablising medication for sufferers of bipolar disorder.
As those who suffer from it know, bipolar disorder is characterised by cyclical swings between happy mania and unhappy depression, with periods of mental peace and tranquility in between. It apparently affects around 2% of Americans and is associated with significant treatment costs, particularly around the medications used to control its effects on sufferers.
Sometimes just one medication isn't enough; often a treating physician will test various pharmaceuticals in combination with each other to create a 'cocktail' that seems to work best for the sufferer. This is true not just for bipolar disorder, but increasingly for other medical conditions as well, including depression.
Of course, whether using one medication or a cocktail, the cost of administration of the medication can be steep: not only the cost of the medication itself but also the cost of monitoring its performance, monitoring the dosing frequency, monitoring its effectiveness, monitoring its tolerability and side effects, and so on.
Brandon Suehs and Tawny Bettinger, two pharmacologists from Austin, Texas, saw a gap in the decision-making process of which mood-stabilizing medication to use with a patient and so sought to develop a model to help their colleagues.
Working with 116 psychiatric pharmacist specialists -- pharmacists with specialist training and practice in clinical psychopharmacology -- Suehs and Bettinger sought to determine the optimum medications based on five descending criteria: Effectiveness, Safety & Tolerability, Dosing Frequency, Monitoring Burden, and Cost.
Effectiveness was a composite score based on a medication's effectiveness in 1) treating acute mania, 2) treating acute bipolar depression and 3) effectiveness in maintenance treatment.
Suehs and Bettinger found that lithium is the most effectiveness across both acute mania and maintenance treatment factors, as well as overall effectiveness; lamotrigine is the medication with the most effectiveness in treating acute bipolar depression. Aripiprazole scored moderately well as the antipsychotic of choice for safety, tolerability and maintenance factors.
Of additional interest was the finding that gabapentin and topiramate scored poorly across all three factors (acute mania, acute bipolar depression and maintenance treatment).
Source: Suehs, B.T., & Bettinger, T.L. 2009. A Multiattribute Decision Model for Bipolar Disorder: Identification of Preferred Mood-Stabilizing Medications. American Journal of Managed Care; 15(7); e42-e52
Please see our medical disclaimer.
Here’s a statement of the bleedin’ obvious: ‘depression increases the risk of suicide.’
But the research community is divided as to whether one of the extremely unwanted side-effects of second-generation antidepressants is an actual increase the likelihood of suicide, especially in the initial phases of medication, or not.