Ingredients

I looked up the inactive ingredients in the generic “equivalents” I had been taking and compared them to the brand name drugs I was prescribed. In the table below, I organized the inactive ingredients list to clearly show which ingredients are shared by the different medications (Zoloft, the generic sertraline HCl I was taking, BuSpar, and the generic buspirone HCl I was taking).

I suspect that ingredients in italics are essentially the same chemical, but with slightly different names. There may be differences between them, but I’m inclined to think that any differences in their biological effects are relatively insignificant.

The ingredient in bold is only present in one medication; interestingly, the medication in question is the generic buspirone HCl. The only explanation I can come up with for why they’d randomly add sodium lauryl sulfate is because they need it in order to get the anhydrous (condensed) lactose to behave similarly to non-modified lactose during production. I find the presence of sodium lauryl sulfate in my medication disturbing, but haven’t found any information to suggest that it might’ve been interfering with the effectiveness of the medication or having noticeable adverse effects.

Ergo it seems likely that if inactive ingredients were limiting the effectiveness of my medications, switching from generic to brand wouldn’t help me much … unless differences in amounts or proportions are significant. I have no idea whether the amounts of the ingredients are the same across the included medications, but each medication had them listed in a different order.

Wakana sat me down at her computer, worked with me step-by-step to find a psychiatrist within reasonable driving distance who takes my insurance, and insisted that I call to make an appointment. I had to leave a message – to which I have yet to receive a reply – but at least I did something. I felt like a huge weight was lifted from my shoulders. And maybe finding out information about other organizations / programs that could help me will be similarly painless … especially if I can do a lot of it online.

One thing I’ll definitely be looking for as I conduct my search for a new psychiatrist will be strong knowledge of how inactive ingredients affect one’s response to a drug, particularly when that may cause significant differences between brand and generic. I need a psychiatrist who will take this concern seriously and be willing to fight to gain me access to the brand drug ze’s prescribing (instead of a generic “equivalent”) if necessary.

UPDATE: I’ve color-coded the inactive ingredients list to indicate possible concerns raised by Disorderly Chickadee in Generic Versus Brand: What’s In That Pill? Part Two. Many thanks once again to DeeDee for compiling the information. Trying to do so myself has been very difficult and frustrating.

Coding scheme:

  • allergen
  • carcinogen
  • toxin, irritant, or other health risk
  • animal product
  • restricted by some religions

Zoloft (50mg)

Sertraline HCl (50mg) Camber Pharm.

BuSpar (15mg)

Buspirone HCl (15mg) Mylan Pharm.

Dibasic calcium phosphate dihydrate Dibasic calcium phosphate dihydrate
FD&C Blue #2 aluminum lake FD&C Blue #2 / Indigo Carmine aluminum lake
Hydroxypropyl cellulose Hydroxypropyl cellulose
Hydroxylpropyl methylcellulose Hypromellose 3cP & Hypromellose 6cP
Magnesium stearate Magnesium stearate Magnesium stearate Magnesium stearate
Microcrystalline cellulose Microcrystalline cellulose Microcrystalline cellulose Microcrystalline cellulose
Polyethylene glycol Macrogol / Peg 400
Polysorbate 80 Polysorbate 80
Sodium starch glycolate Sodium starch glycolate Sodium starch glycolate Sodium starch glycolate
Titanium dioxide Titanium dioxide
  Colloidal silicon dioxide Silicon dioxide
  Lactose Anhydrous lactose
    Sodium lauryl sulfate

Prescription by Dr. Ziya

WARNING: This is a (potentially risky) decision I have made for myself. It does not take the place of medical advice by a qualified mental health professional.

Today I had a conversation with 2 friends that confirmed a few thoughts I’ve been having:

  1. I will not go back to Psychiatrist B under any circumstances.
  2. I need to stop taking my current medications.
  3. Listening to music daily will improve my mood and possibly also my brain’s functioning.
  4. I need to be honest and talk about my disorder more often.

Psychiatrist B didn’t take my thoughts about harming myself and even committing suicide seriously, despite the fact that the drug he was prescribing me can cause such thoughts. He also needed assurance from me that it was worth gaining weight to have the possibility of recovering from a disabling disorder; that my mental health is more important than my appearance! (He also made the typical assumption that fat = ugly, which I have no desire to perpetuate.) As one of my friends put it, there’s a significant risk that if I keep going to this doctor, his problems will have a negative impact on my well-being. It also certainly doesn’t bode well that the “clinic” hasn’t made any attempts to contact me about rescheduling the follow-up appointment I canceled nearly a month ago.

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long-white-pillsRegarding my medications, the bottom line is: they’re not providing the relief I need. Regardless of whether they’re helping “somewhat,” the fact remains that they are not helping enough. And there’s the possibility that they are causing or contributing to some of my more disturbing symptoms. I haven’t been taking them for the past few days and to be honest it’s been a very rocky road. At this point I’m unsure whether I should hold my ground until they’re completely out of my system – or start taking them again in smaller and smaller doses until it’s safer to stop completely (or I run out). Everyone seems to think it’s better to wean myself off them slowly, but I’m concerned about what might happen if my levels spike again after being so low for the past couple days. It’s also a lot easier to just not take them than to try to figure out what doses would be appropriate and remember to take them regularly.

It’s recently come to my attention that I’ve been doing my readers and the companies that make certain brand-name drugs a disservice. I’ve been taking generic “equivalents” of Zoloft and BuSpar (sertraline HCl and buspirone HCl, respectively); prior to beginning this blog I was taking bupropion in place of Wellbutrin. Anyone reading my blog would think I was taking the brand-name drugs and that they were causing or contributing to the undesirable effects I’ve described. This is most certainly not the case. In Generic Versus Brand: What’s In That Pill? Part 1, Disorderly Chickadee sheds light on how generic formulations of brand-name drugs often are not as effective as the brand-name version; in some cases the difference in functioning one experiences can be “like a brain transplant.”

Most notably, there is a huge difference between Wellbutrin and generic bupropion, enough so that one generic formulation was recalled. It’s not the one I was taking, but it still raises some suspicion that I might have done a lot better if I’d taken actual Wellbutrin instead. I’m also wondering whether brand-name Zoloft and BuSpar would be more effective (and safer!) than the generic sertraline HCl and buspirone HCl I’ve been taking.

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bob marleyI don’t usually listen to music, unless you count the background stuff in Oblivion – which either alerts me to the presence of enemies or puts me to sleep. Yesterday I had the very pleasant experience of listening to some of the more upbeat tracks on a CD of instrumental Celtic music. The bass and percussion were very grounding and calming, helping me to feel safe … while the foregound instruments were lively and played complex melodies in compound meter.

MeterI had a lot of fun listening to the music, felt calmer and happier, and thought it was having a desirable effect on my brain. It required enough of my attention that there was little to no room left for disturbing thoughts, and it seemed to help organize my brain. My hypothesis is that the regular firing of neurons involved in listening to the music (which are located throughout the brain) may have provided the stimulation, serotonin, dopamine, and information pathways my brain needed to function more effectively. I might need to experiment a bit to figure out how many times per day and for how long I should listen to music, as well as what types of music will provide the best effects … but overall I’m optimistic that listening to music regularly will help – a lot!

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meep-and-lolz-cropFinally, it felt really good to be honest about what I’ve been struggling with and have my friends accept my reality. They listened and shared their own related experiences, which helped me feel less alone in my struggles. They offered advice – some of which I found helpful – but more importantly demonstrated that they support me in my efforts to take care of myself. “You know you can call any of us any time you need to talk, right?” Yeah, I do; I just need a reminder that there are people who want me to reach out to them in my times of greatest need, when I feel like I’d be doing everyone a favor if I just ceased to exist.

Into Darkness

Today I brought Mom to outpatient physical therapy (PT) for the first time. She kept asking me to go in with her, but was able to operate the handicapped person’s elevator by herself. Other people opened doors for her. As soon as she entered the place proper, she seemed to forget I was there, trying to figure out whether I should help her, and if so what I should do.

Once Mom was happily at PT, Fox and I went to a relatively nearby movie theater to see Star Trek: Into Darkness. I’m going to try not to give spoilers but I will say there were a lot of explosions. Overall, it was an excellent movie and I’m really looking forward to seeing it again. If I do so in theaters, I’m bringing earplugs.

Anyone watching me during the movie might have thought I hated it, though, and seriously wondered why I didn’t just get up and leave. I spent significant portions of the movie clinging to Fox for dear life – much the same way I clung to a previous significant other when we went to see Silent Hill, a horror movie that quite thoroughly terrified (and traumatized) me. Especially during fight scenes (in Star Trek), I was shaking, looks of panic on my face, holding my head in my hands, my body very tense, insisting that Fox hold me. It was, in short, a very strong anxiety reaction. Even afterward, when I went to the bathroom, I started shaking again and felt like I was on the verge of tears.

Don’t get me wrong, I was very immersed in the movie. The acting, the music, the effects, and an engaging plot all came together to really pull me into the overall experience. I could relate to and empathize with the characters; I cared about their well-being. So my physical responses do make sense with what I was thinking and feeling in response to the movie. They were just taken to what I perceive as an extreme that does not reflect my actual degree of emotional response. Nothing in the movie was particularly terrifying or anxiety provoking; I haven’t been traumatized by it; intellectually I knew I was perfectly safe, sitting in a movie theater being entertained. But the way my body responded, you’d think I was convinced my life was in serious danger.

It was extremely loud in the movie theater and I think (hope) that was a significant contributing factor. That said, I think the metallic timbre of the explosion and especially gunshot sounds was the main trigger for my anxiety response. It’s possible the motion (visual input) might have also played a role. It’s hard to say what role the music played because I wasn’t focusing on it during the most anxiety-provoking scenes, but I did notice that at times it was very intense, with loud rapid high-pitched passages played by the string section of the orchestra (e.g. violins). Again, I think my response was “normal” in terms of its quality, but not its intensity.

I’m pretty sure it’s a side effect of the medications I’m on. One of the “infrequent” side effects listed for Zoloft is hyperesthesia – increased sensitivity in one or more senses. Now that I know that, I can save a lot of time trying to explain my experiences to my next psychiatrist and simply tell zir I have “auditory hyperesthesia.” Additionally, an “infrequent” side effect of BuSpar is noise intolerance. I’m not sure whether that’s the same thing / similar / related, or something completely different. But it’s definitely been affecting me in my daily life. Among other things, it’s harder for me to shop for items I need and make decisions because I can’t tolerate the noise (especially music and advertisements) in a lot of stores.

We went back to the PT place to pick Mom up, getting slightly lost in the process. Fox was geekgasming about the movie and its relationship to classic Star Trek. It’s the kind of thing I love to watch and listen to, but find distracting and irritating when I need to concentrate on driving. Then his mom called; I asked him to put her on speaker phone so he could help set up my GPS and I could be part of the conversation. We stayed on the phone with her for a little while after picking up my mom, who quietly complained to me that she had been waiting for us for over an hour. I think she should have been the one to do this, but I stepped up and politely told Fox’s mom I was enjoying talking to her, but let’s continue this conversation later.

Then there was driving around in circles in traffic, shopping, eating at a somewhat noisy establishment, listening to Mom, trying to express some of my needs to her – such as my need for a day (or two) to myself every week – feeling like she didn’t quite catch my meaning, and trying to cope with a splitting headache. By the time we got home I was furious! I think it’s because here I am struggling with all this shit and she just keeps asking more and more of me and no matter how hard she tries to be nice and considerate and show her support I feel like she just sees me as someone to do shit for her. A servant. Is it my hangup or something about her? I don’t even know! It drives me crazy.

But the point is when we got home I was furious. Rat therapy helped me calm down. Fox ended up doing laundry for all three of us while I took a nap; I’m torn between being very grateful and feeling guilty about “making” him do my mother’s laundry. That just seems to be breaking some kind of unspoken taboo.

Wakana had to cancel both our meetings this week because she’s been sick so I can’t even take my frustrations out on the cymbal receive the support and therapeutic experiences I need from her. (I’ll admit I’m a bit annoyed about that, but I can’t believe she’d take a week off from work unless she had a really good reason to do so. It’s not like you can get paid sick days in private practice.) So I get to drive Mom to and from PT tomorrow (and possibly other errands), but I don’t get to have the professional help I desperately need! It’s not fair!

Please help support my blogging habit by buying products related to Star Trek on Amazon.com; you can even pre-order Star Trek: Into Darkness.

Off My Meds

I’ve been off my meds since Thursday, when I discovered I’d run out of Zoloft. Friday was a bit of a mess, to put it mildly. Fox came over and we went to my local pharmacy – I had missed calls from them, which I thought were letting me know my prescriptions had been refilled and were available for pickup. No, they were refill reminders. I didn’t have the mental capacity to deal with the situation that day.

On Saturday I brought my rats to the vet, which basically ate up the whole day. I felt tired and disengaged even when spending time with people I care about. Sunday was my first opportunity to refill the meds; I put in an order online intending to pick it up later the same day. The pharmacy closed early because it was a Sunday. Boo hiss. We were up late last night, so we slept late, so we’re sitting here in our pajamas being internet zombies instead of doing useful things like getting the drugs my brain needs to function.

I hate meds. They make life too complicated. Yet another thing to remember and have to deal with random strangers in order to maintain. I’m tempted to just go off my meds and have one or two daily doses of ZooBorns instead. The adorableness is much better at getting me out of my own head, energizing me, and helping me feel happier than meds will ever achieve. And it’s educational: there are adorable photos of babies from species I didn’t even know exist!

Having Fox around more will help too. Mom officially agreed to his request to move in. So, we only have a few more weeks of the instability that drives the Deserter crazy. Then … well, everything comes with a cost. I don’t know what the cost of Fox moving in will be yet. I just hope the benefits outweigh it.

Yuck. I feel like crying but I probably won’t. I feel like going back to sleep. I need to call the vet because one of my rats isn’t using his left hind foot. I’m not sure if it suddenly started yesterday or has been gradually developing and just became more apparent than ever when I took him out to play. I’m dreading trying to explain the situation, making (and later keeping) another appointment, and the bill … ugh, bills! Why me?

hmmph. It’s time to get back on those meds. Even if they’re not quite right, they seem to be better than nothing – especially if I manage to take them with some semblance of regularity. If I’m taking them, I can give my psychiatrist something to work with. If I’m not taking them … well, we’re all wasting our time and money.

Finding the Right Medication – Part Five

On Wednesday I met with Psychiatrist B for another 2-month follow-up. I told him about the increased depressive symptoms I’ve been having and the situational factors involved. He gave me relatively useless advice on what to do about my relationship with my mother and told me I have to take responsibility for my schoolwork (instead of, say, smashing the clock). I couldn’t get up the nerve to mention my recent suicidal thoughts or the freezing Wakana had helped me label (Using Words to Say What They Cannot). On a rational level I knew if I was going to talk to anyone about those symptoms it should be my psychiatrist, but on an emotional level I just didn’t feel safe doing so.

Psychiatrist B decided to stay with the Zoloft at my current dose (50mg 1x/day) and add another medication that’s used to treat anxiety. I don’t remember how he pronounced it and I can’t read his handwriting, but I was able to make out the first few letters. When I typed them into the search bar on drugs.com, it recommended BuSpar.

Based on the information on the website, my only concern is the risk of interaction between the two drugs, which can result in the serotonin syndrome I believe I experienced near the end of October (Finding the Right Medication – Part 2). At that point in time, miscommunication resulted in an overdose; this time I have very clear instructions on how much of each medication to take, and when. He’s keeping me on a low dose of the Zoloft and having me start on a low dose of the BuSpar, increasing it gradually over the course of 5 days.

The thing is, I have no idea what’s going to happen. Based on user reviews, the effects of the drug seem to vary pretty widely from person to person. It could work great with minimal side effects, or it could make me so dizzy I can’t read for school. And worse.

I’ve spent an inordinate amount of time playing The Sims 3 over the past couple days. I played until the children from Ending a Life grew up into teenagers, then decided I wanted to have family portraits that included the patriarch and recently-deceased matriarch. So, I created a new game and restarted playing this family from scratch – only to have the game barf on itself when I tried bringing my intended photographer to Egypt so she could learn her craft. (World Adventures expansion: visiting Egypt is the only way to acquire a camera and learn photography.) After several repeated attempt I concluded that the save file was corrupted. I had to restart my game again; this time I sent her to Egypt first and everything went smoothly – in the game, that is.

I, the embodied Ziya, have been eating crap, depriving myself of sleep, neglecting my schoolwork and other responsibilities, ignoring the pain in my wrist and shoulders from sitting in a weird position for hours on end, and allowing my space to become (more) cluttered! I’ve put off filling the prescription for the past two days, denying myself a medication that could (perhaps, if I wiggle my toes the right way) actually be helpful!