Finding the Right Medication – Part One

It is hard to say how long I have been severely depressed: sad, with very low frustration tolerance, and lethargic most of the time. But by mid-late July 2012, I was frightened enough by my suicidal thoughts and compulsion to hurt myself that I decided it was time to start taking medication for my depression. My music therapist agreed with me and recommended Psychiatrist A.

Psychiatrist A does not accept insurance, so I had to pay him $250 in cash – and that was a discounted rate! Based on our conversation, he suggested that I try Wellbutrin. He gave me a one-week supply of 150 mg extended-release pills and a one-week supply of 300 mg extended-release pills.

During the first week, taking 150 mg of Wellbutrin each day, I felt as though nearly all of my symptoms were significantly improved! At times it almost felt like I had too much energy! – but it was a very welcome change from what I had become accustomed to. After a while, I started to settle down. I still felt much better, but I was no longer bouncing off the walls.

During the second week, I started taking 300 mg of Wellbutrin each day. I had a panic attack on the first day, but attributed it to the fact that I had taken that day’s dose a few hours less than 24 hours after the previous day’s dose, so I probably had too much of the medication in my system. Sure enough, I responded better to the medication in following days when I took the doses about 24 hours apart. I felt more motivated, had the energy to do what I wanted, and was in a better mood.

Except that each night I had horrible chest pains. I tried to keep calm and tell myself I was okay, but I couldn’t sleep. I tried to find information about what it might be online, but the more I read the more convinced I became that there was something wrong with my heart. I was having a heart attack. There was a blood clot in one of my essential arteries. The medication was causing the blood vessels in my chest to constrict and spasm. Whatever! Each night I was taking my life into my hands; I had finally decided not to kill myself but I was convinced I would probably still die.

Finally, after nearly a week of this, I had a night were I could not sleep, so I decided to call my mom. She picked me up and, since it was the middle of the night, took me to the emergency room – despite her conviction that I should wait until morning to go to a regular medical facility. Sure enough, by the time we actually got to the hospital, I was starting to feel better. All the tests they did came out completely normal; I discovered my heart and I are actually in excellent health! So healthy, in fact, that I managed not to have a real heart attack when I received the hospital bill …

I called Psychiatrist A about reducing my dose and we agreed that it would be safest to take me back to 200 mg per day. He told me to take a 100 mg slow-release pill twice each day. Without more specific instructions, I decided to take the pills 12 hours apart – which, due to my sleep cycle, tended to mean taking the second dose at midnight or later. It took about four hours for me to wind down after the second dose, so I basically became nocturnal.

A friend who also takes two doses of Wellbutrin each day told me that he takes them about 6 hours apart, and I should never take the second dose after 8pm. I tried following his advice, but it wasn’t always easy.

Over the next couple of months I often found myself angry, and while my depression wasn’t as bad as it had been I was unsatisfied with the effects of the medication. The depression was still interfering significantly with my ability to enjoy myself and take advantage of career-related opportunities that involved interacting with people. My self-esteem was too low for me to feel comfortable trying to make a good first impression, and my energy level and mood were also too low. I didn’t want a potential employer to see me on the verge of tears!

(to be continued)

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