Thursday, November 22, 2007

Playing doctor

My psychiatrist is so comfortable with my knowledge of pharmaceuticals and my diligent pursuit of knowledge in that regard, he doesn't have any reservations about me tweaking my own meds. It helps that I'm responsible and I don't abuse, well, anything except my own self-esteem.

Toward this end, I'm making an adjustment to my EMSAM. In case you missed it in earlier posts, this is the $472-per-month miracle that gave me my life back. And massacred my bank account. EMSAM is a transdermal form of an old drug--selegiline--an MAOI. It is prescribed for major depressive syndrome, and works especially well for those of us who have hellacious reactions to SSRIs. When you have a condition as complex as bipolar disorder, having an entire class of drugs taken off the treatment table is reason for serious dismay.

EMSAM has two major drawbacks, and they are so significant as to classify this medication as an "after everything else has failed, try this" kind of medication. The first issue is that EMSAM is contraindicated with almost every other drug on the planet and quite a few foods, as well. In other words, if you can't self-monitor and pay attention to what you're putting into your body, this is not the drug for you (unless the threat of hypertensive crisis doesn't make you flinch). The medication itself causes an astounding change in blood pressure all by itself, so the contraindications need to be taken seriously. I've had freakishly low blood pressure my whole life, but in the 17 months I've been using EMSAM, I have developed high blood pressure.

The first and most significant side effect of this medications is...drum roll please...insomnia. At the time of year when so many people north of the equator are fighting off the urge to hibernate, I am hopelessly sleepless. I'm not like Martha Stewart, who sleeps four hours a night and goes about her day without any ill effects (other than being a supreme bitch, which may just be a character flaw). No, I need sleep or I risk going into a tailspin of mood and functionality.

So, in an attempt to alleviate my chronic, severe insomnia, I'm knocking down my EMSAM to the beginner dose of 6mg--a 30% decrease. A bold move at my most vulnerable time of year, I know, but if I start backsliding, I can always bump up the dose. I love playing pharmacist. Bwahahaha!

This reminds me: I want to write a letter to Bristol Myers Squibb. You know, if you look at other transdermal medications like nicotine patches or motion sickness patches or even hormone patches, the medication identification is on the part of the patch you peel off and throw away. EMSAM, on the other hand, has the name printed all over the patch itself. Anyone standing within a couple of feet of me can clearly read the word "EMSAM" printed again and again on the face of the patch. All they have to do is Google the name and my most personal secrets start to be revealed. It's not a big problem in the winter, but my patch placement has to be a lot more creative in the summer months if I am to maintain any privacy and discretion.

What the hell were they thinking over there in Somerville? I might as well be wearing a shirt that says, "Ask Me About My EMSAM." I am currently working on some kind of totally outrageous lie of a story. Hmmmmm. Creative lying to avoid embarassment. Hmmmm. Bwahahahaha!

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