Tuesday, February 10, 2009

Treatment Update



It's that time of the week again!

Anyone who has ever been on multiple medications for any condition knows that every drug interacts with another in some form or fashion. Side effects are inevitable. For the past week or so I've been struggling with grogginess from one med (Seroquel) and obscenely dilated pupils from another (Parnate). It is entirely possible that these symptoms will subside with time, but in the meantime it has not been pleasant. Today, however, has been better.

As for dosage changes, Parnate was increased to 30 mg yesterday. The regimen is broken down into two sections to minimize adverse effects--2 pills in the morning, 1 pill at noon. Furthermore, I have been pleasantly surprised as to how well Lithium has been keeping away even the beginning stages of manic symptoms. As I was told by my doctor yesterday, Lithium has, for many patients, been known to increase the beneficial effects of other psychotrophic medications used simultaneously to treat bipolar. Seroquel will eventually be decreased back down to 400 mg, where it was for a week or so last month. 400 mg was the dosage level I was on when I entered NIMH treatment back in late October.

Yesterday, during consultation with my psychiatrist, I was told that I'll be discharged and heading home within two to four weeks. Once my condition is better regulated, I know they'll feel more comfortable with releasing me. There is another factor as well in my leaving sooner than expected. When I entered treatment three and a half months ago, the unit was only half full and new patients entered only at a trickle. Now we are at full capacity. Every bed is taken. We got a huge influx of new patients within the last three weeks alone and this will continue for a while. A waiting list exists now and the doctors will be pushing as many people out as possible to accommodate new research subjects.

I am not in active protocol right now, so I am aware that my leaving soon is just a matter of time. As you'll recall, I didn't sleep for a week solid due to the fact that I'm an insomniac and simply cannot obtain sleep by natural means. The studies here had rigid criteria and in order to qualify for them, one couldn't be on any medication at all except for a mood stabilizer like Lithium or Depakote. While I'm thinking about it, I could have participated in another trial, but I would have been taken off of Lithium altogether, and the doctor believed that being on the old gold standard for manic depression was the only reason I didn't experience cycling moods or psychosis when I hadn't slept several days in a row.

Still, I will be completely honest. I disagree a little with the methodology used here in treatment. Two of the studies offered for bipolar patients offer limited relief. Ketamine shows significant promise as an anti-depressant, but the way the protocol is administered, the most relief any person ever receives is four to six days. Only one infusion is given and the dosage is so minute that a recreational drug user would laugh at how tiny it is. A placebo infusion is given as well, as one would expect in a double-blind study. If the active agent were given frequently, like say every day, no one would experience significant depression, but the point of the study apparently is to measure how long a person can maintain a normal mood with only one treatment. It's almost sadistic in a way to contemplate, observing these people who have been mildly to moderately depressed beforehand get the infusion, enjoy four or five days of feeling euthymic, then see that good mood slipping away like sand between their fingers.

Another study uses Riluzole, a drug developed for Lou Gehrig's Disease, which in all my time here, I have never really seen significantly help anyone. Much of this is because every day a person is given a 50/50 chance of receiving either active agent or placebo. Psychotropic medications require a build up over time to work properly. One can't expect to feel better if one takes a drug every three days or even every other day. With time, some mood-improving effect will transpire, but it will be quite minimal. Medications which work specifically on the neurotransmitter glutamate are what every research institute in the world is pursuing at the moment and Riluzole is believed to have some action on it. Yet, I cannot help thinking that this particular trial is a bit like shooting in the dark, hoping to hit something.

Other studies are being developed, but most of them are limited to uni-polar patients, because one needs only account for depression in documenting the results, not mania or hypomania. I suppose then the results are less debatable, less complicated, and less subject to criticism from the medical community. It seems a bit unfair, really. Two promising medications are an anti-anxiety medication called NR2B, which is named after the neuro-receptor upon which it works directly, and a brand new study that works on opiate receptors. Still, yet again these are only being tried on patients who have experienced only depression, and not mania or hypomania. As the doctors have told me, many of these trials are never offered for bipolar patients because if they are offered for manic depressives, few are capable of making it through the entire process and resulting trial without cycling to some degree or another.

I know I'm in the end stretch now and I intend to make the most of my remaining time.

4 comments:

FranIAm said...

Thanks for the update - I really admire you for all you have been through and your perseverance Kevin.

You are in my prayers, I hold you in the Light daily.

PENolan said...

I, too, hold you in the light. I'll miss having you just down the road in DC. You're calling the female from the party tomorrow?

Liberality said...

You have been through quite a lot haven't you? Even if you get little benefit out of your participation, you have helped modern medicine, right?

Comrade Kevin said...

Nolan,

Thanks much! I'll miss you too. I really like DC and if there were any way for me to stay healthy for long I'd find a way to move here permanently.

To answer your question, I actually changed my mind and contacted her this morning. All went well and our first date is set for Thursday night. I'm excited!

Liberality,

Yeah, I kinda have been through a lot, haven't I?

And yes, even though I personally got mostly just a four month change of scenery, a new medication cocktail, and a different set of doctors I have helped out. More than one person on staff here has assured me that they learned quite a bit from my presence on the unit.