And, just like that ...

For much of the day, I said to myself and to a couple of people, "I wish I could just get better." Not only was it difficult to do more than the ADLs, anything that looked like creativity was stuck way off shore, barely visible at the horizon.
In the late afternoon, I get an email from a list that shares information about technical writing and related jobs. It's a short-term training job in Worcester, presenting a variety of web topics to hospital employees. It's a perfect match for the kinds of things that I've been doing. Within minutes, I quickly reviewed my resume, made a few changes, and sent it along.
I'm sure that the hiring manager will be inundated with responses, so I'm not expecting a quick response or even an acknowledgment. It was just good to take a chance and trust that the process will lead me to the next place.
Sure, I've thought about what it would be like to have to go to work on a regular schedule, complete projects on time, and all that. As I said, I have to trust the process. The interviewing loop (if I even get there) will show me more of what's needed and more about my capabilities. I'll have plenty of time to learn about my rights regarding any accommodations that I might need. There are a few areas where I'll have to be a quick study (search engine optimizations, server logs for a particular content management system, and the like), but there are also other areas where I know the material as well as anyone might.
Just as hard things can show up unexpectedly, taking control of one's life, so, too, maybe, good things can behave similarly. We've plenty of time to figure it all out. I take that back. We don't have to figure it all out. We just have to figure out enough to move forward.

Identity

I have some friends who use labels to characterize and summarize their behaviors. ("Oh, that's my OCD kicking up again.) The labels can be diagnoses, astrological signs, regional descriptors (I'm just a Yankee and so ...), birth order, or any of a number of things. The labels are useful because they quickly package a set of attributes into a manageable chunk. They're unhelpful because the labels might have only a 60% fit; the other 40% has to be discarded as irrelevant.
We're often coached in therapy to refer to ourselves as people with mental illnesses, not as mentally ill people. I am a person with depression; I'm not a depressive.
Further, as we know, the diagnosis of depression includes a very broad array of symptoms. When we take screening tests, the results are often reported as "If you answered 'Yes' on five of seven, 13 of 19, " or somesuch.
And even if we arrive at a diagnosis based on the presentation of enough symptoms at enough severity, that doesn't typically get us very close to identifying a cause. Depressive symptoms are serious enough that they warrant treatment, irrespective of the cause. (As we know, left untreated, depression can be life-threatening.) Finding treatments that work (i.e., relieve symptoms) can take a lot of time and experimentation.
[Another time, I'll explore what seem to be the two camps of treatment - medical vs. behavioral. There's a lot of interesting science coming out in both areas.]
So what? Well, I backed into these ideas as the result of an old theme, that revealing one's depression is a great conversation stopper. I've had the chance to reconnect with several friends from long ago. When they ask what I'm doing these days, I try to calibrate my response. If they were work acquaintances, I say that I'm retired. I might say that I've retired for medical reasons, leaving the topic open. If I knew them well, I will often go into a fairly brief description of leaving work, receiving treatment for depression, and living now. Some people will respond with an "I'm sorry that that has happened to you." Others might related their own experiences or that of family or friends.
Often as not, the response is crickets.
That's led to reflection on how we present ourselves to friends, family, and others. Most people, I believe, are prepared to hear that everything's fine. They may not be prepared to hear about some complicated hardship. Nevertheless, to present myself in the camp of everything-is-fine is not fair to me or to the relationship.
As a result, I wind up missing these old friends more after I've made the contact than before.
One final wrinkle that helps little: we generally use the word identity to describe how we define something or someone. In mathematics, however, an Identity describes the behavior of the integers 0 or 1. If you add 0 to any number, you get the original number. If you multiple 1 by any number, you get the original number. See how much that helps?

Got lucky

No, not in that way.
Last night, my wife and I had a date night. We dressed up a bit and went to dinner at a favorite Thai restaurant. The place opened last December and has been very successful, so we went early to eat without having to wait or hurry.
We'd worked hard during the afternoon, attending to some long overdue chores inside and outside the house. As a result, we were hungry. We shared an appetizer platter before order our entrees. My wife likes a chicken and squash dinner. Most of the time, I've ordered the Massman curry with chicken or beef. This night, however, I selected the panang curry. It was delicious. I think that the regular recipe was supplemented with a bit of anise, a sweet licorice aftertaste.
About one in the morning, I woke with a pretty bad headache. I got up, went downstairs, and, while waiting for the ibuprofen to kick in, I put an ice pack atop my head. The cold felt very good.
A short while later, I looked up the recipe for panang curry and learned that it's made with fish sauce, which is a fermented product. Fermentation produces a chemical called tyramine. For someone, such as yours truly, who is taking an MAO-I antidepressant, tyramine can be deadly. I was fortunate that the amount of fish sauce in the dinner was small enough to produce just a bad headache.
The menu description didn't mention fish sauce:

Panang Curry Choice of chicken, beef or pork in Panang curry with string bean, carrots, basil leaves and kaffir limes leaves.

Had I known, of course, I wouldn't have ordered it. Now I know.
A big part of the problem is that I didn't think to ask what was in the curry. Other curries, Thai and south Asian, have been fine - delicious and safe. It's not that I didn't know, but that I thought that I knew.
I got lucky.

Depression's Evolutionary Roots: Scientific American

Depression's Evolutionary Roots: Scientific American:

"When one considers all the evidence, depression seems less like a disorder where the brain is operating in a haphazard way, or malfunctioning. Instead, depression seems more like the vertebrate eye—an intricate, highly organized piece of machinery that performs a specific function."

The latest in the depression-must-mean-something meme.
I wish I could believe it. I wish that the periods of depression, when nothing moves and all is dull, were leading to better insights about life's problems, mine or the greater good. My experience has been, however, is that I'm not capable of much thought during those times. I don't, as the article suggests, ruminate on topics that require deep and sustained concentration. No, my time is usually spent staring at the opposite wall, my focus about six inches before I reach the wall, so nothing is clear and less is important.

"Laboratory experiments indicate that depressed people are better at solving social dilemmas by better analysis of the costs and benefits of the different options that they might take."

Maybe, and I'm not being too snarky here, we ought to move into laboratories. What I've seen out here, in my life and the lives of nearly all people with severe depression, is that depression wrecks relationships and drives people into repeated episodes of bad and/or self-destructive behavior, often in an effort to find relief from depression.
I commend the article's author for trying to identify something good that can come out of depression. I don't rule it out. I just know that I don't want to go back there, no matter how my analytical skills might improve.

Several more clips about insomnia

• The No Wake Zone
  "There’s accumulating scientific and historical evidence that human beings, like many of our mammalian cousins, weren’t meant to follow what we consider a “normal” wake-sleep pattern of two strictly segregated blocks of time—16 uninterrupted hours awake, 8 uninterrupted hours asleep."
  
• Sleep Patterns In Children And Teenagers Could Indicate Risk For Depression
  "adolescents with a familial risk for depression but without a depression diagnosis experienced shorter REM latency, meaning they reached the REM stage more quickly. Those adolescents were more likely to develop depression by the end of the five-year study period than those who reached REM sleep later in the cycle."
  
• Bedfellows: Insomnia and Depression | Psychology Today
  But it may be that insomnia is more than just a symptom of depression. It may in fact unleash the mood disorder. If sleep researcher Michael Perlis, Ph.D., is right, insomnia may be an early harbinger of depression. His longitudinal studies show that it appears to precede episodes of depression by about five weeks.
  


• Gene May Determine How Much Sleep You Need : NPR
  "A team of researchers has found a genetic mutation that appears to allow some people to get by on less sleep than others. The team found the unusual mutation in a mother and daughter pair who appear to sleep less."
  

Why You Should Hate the Idea of Applying for Disability Beneifts

Why You Should Hate the Idea of Applying for Disability Beneifts: "In my view, clients who hate the concept of disability are my best clients."

Online Insomnia Programs Promising, Studies Show

Online Insomnia Programs Promising, Studies Show – NYTimes.com « jumpstarting a life with a little spark to the head

Mentally Ill Offenders Strain Juvenile System - NYTimes.com

Mentally Ill Offenders Strain Juvenile System - NYTimes.com: "one challenge in dealing with large numbers of psychologically ill youths is determining who is “mad versus bad.”"

For science

Yesterday I met with a team from UMass Medical School that is researching treatment-resistant depression (TRD). I have applied to be a participant in a registry of patients with TRD whose progress (or lack of) will be compared against people receiving Vagus Nerve Stimulation (VNS) therapy. I won't be receiving VNS therapy or any other treatments; I'd be part of the control group. As a result, there's little risk and a good chance to be a part of some important research. More about the registry here: http://www.trdregistry.org/.
The meeting yesterday lasted nearly two hours, covering my history of depression and the various treatments that I've tried, noting how well each treatment worked. It was a bit odd to try to define each 'episode' of depression. The last three years, for example, can be chunked into several episodes, based on the treatments that we've tried. I also see it as one long episode that hasn't ended. (Even though I'm doing pretty well much of the time, there's no doubt that I'm still dealing with depression as a regular part of my daily life.)
In addition, the renewed and detailed discussion about my depression history was wearing. I'd had awakened from a bad dream yesterday morning, a dream about misjudging my abilities and overestimating how much people wanted to hear about what I thought about everything, and so went to the interview feeling off my game. I found myself tearing up a few times as I recounted various parts of my life, but those feelings passed quickly and the rest of the day was pretty much ok.
Within a couple of weeks, I should find out if I've been accepted into the study. If so, I'll have interviews every three months for a couple of years and twice-yearly interviews for a few more, totaling 14 over five years.
I could not have predicted, five years ago, that this is how my life would be and so I'm doing even going to toss out a wild guess about what things will be like five years hence. I'll just keep showing up.

How to decide how much to reveal about yourself

How to decide how much to reveal about yourself | Penelope Trunk's Brazen Careerist

Insomnia

Midnight is the first minute of a new day - Gil Scott-Heron.
My night-time sleeplessness is back. On a good night, I'll get three hours of sleep before I'm awake; some nights it's an hour-and-a-half. (I've got a pretty reliable 90-minute sleep cycle.)
It's not good. I know it. I read the stuff in the journals about the effects of lack of sleep. During the night, I might get another sleep stint on the couch and, depending on the day, I may need and get one more more. Rarely does it add up to more than six hours in a 24-hour period.
I'm in my head often enough to know some of the things that I'm thinking and feeling that accompany the insomnia. I can't say that those things cause my lack of sleep, only that they're there at the same time.
The coaching that I've received suggests exercise, quiet time before bedtime, no caffeinated products after noon or so, no heavy meals late in the evening. There are also positive things to do, such as variations on meditations, relaxation responses, listening to the radio, not listening to the radio.
I'm also taking a prescribed sleep medication that's supposed to have a long half-life and so should help me stay asleep longer. (I rarely have trouble falling asleep at the prescribed time, between 10 and 10:30.)
I don't say that noting works for me. I just haven't a reliable combination of practices. Yesterday, for example, I walked five miles, half in the morning, half in the afternoon. I did have one diet Coke with supper, about three hours before bed. I also had a stimulating conversation during dinner out with a couple of friends. Lights out at 10:30, awake at 1:30.
For the past couple of years, I've kept detailed notes about the amount of sleep that I'd get each day, exercise, meals, snacks, and items of note. That data hasn't yielded anything meaningful and only adds work. So, I'm taking a break. I do keep track of my activities each day and ensure that I average 30-60 minutes of exercise each day.
Acceptance doesn't mean that I'm giving up or giving on, only that I accept that this is what's happening now and, while it's happening, I will try to make the best of it. If there are other ideas, I'll consider them and, most likely, give them a try. In the meantime, my day starts when I wake up, be it 1:30AM or some other time. Some days, my day starts several times. That's not a wholly bad thing.

ECT on the front page of our hometown paper

From the 9 July 2009 Worcester Telegram and Gazette: ECT debate: A danger, or effective therapy?
My experience with ECT (Electro-convulsive theraphy, colloquially known as shock treatments) has been positive. I believe that it broke the cycle of depression in a way that other treatments - medications or various forms of psychotherapy - could not. It's been more than a year and half ago since my last treatment. Since then, I've had some bad days, but nothing as severe as I'd experienced in the time before ECT.
Dr. Serge Botsaris, cited in this article, has been my doctor for several years. He and his staff have treated me with ECT.
I'm not going to get into the argument about the safety or efficacy of ECT for anyone else. Each person, in close consultation with doctors, family, and friends, needs to make that decision individually. In my experience, I believe that I received a great benefit and, if needed, I would have the procedure again.
Two notes on side effects:

• The major risk, in my opinion, comes not from ECT itself, but from general anesthesia. All but one of my ECT treatments took place at St. Vincent Hospital. The other one was at UMass. There they used a different anesthetic. My O2Sat levels fell into the 30s. (Anything below 90 is usually cause for alarm.) I recovered without any apparent long-term effects. Subsequent treatments were uneventful.
• I did experience one curious type of memory loss, what I call geographic memory. After the ECT treatments, places I'd known well before were unfamiliar on first visits. Downtown Worcester, for example, might have been downtown Biloxi. That condition has improved as I build up new memories of these places.
  There may be other memory problems that I can't identify, but many of those could also be attributed to the depression itself or increased mileage on the brain.

I should also make clear that ECT, as with any of the other therapies available, is not a cure for depression. It's a treatment that relieves symptoms and allows the patient to get on with life. There is, to my knowledge, no cure for depression, only relief from symptoms and periods of remission.

[In the case that the link to the original is unavailable, I've saved a PDF version of the story here.]

Dept. of liver

There are several reasons why I am glad to be taking Emsam®, an MAOI antidepressant:

• It works.
• It's easy to use. It's a patch that I change daily. 
• The dietary restrictions related to MAOIs, although challenging at times, give me an even better excuse not to eat liver.
  There are some folks who have discovered that liver is, to quote, "Energy-boosting, mood-lifting, and frugal."
  Back in the day, my mother believed that liver was good for us and served at least once a week. When she wasn't looking, I gave the liver to the cat or, in one case, hid it in the cupboard. (I forgot to remove it later, which is how she found out.)
  

Voices in a dream

First of all, I don't make fun of schizophrenia. I've seen too many wonderful, smart people taken out, some to return with good, but very constrained lives, others not all.
In that context, then, let me mention a dream that I had the other night. The details have faded, but the details weren't that significant.
The dream was about Facebook and the cacophony of voices, speaking, shouting, singing - all directing me to do jump here, go there, or stand in one place, starry-eyed and laughing.
The raw emotion has lingered for a couple of days, keeping me off-balance. I looked up some of the primary presenting symptoms of schizophrenia, but decided not to push the metaphor too far.
We all have exceptionally vivid dreams at one time or another. When I've changed medications (which I haven't for several months), I experienced episodes of vivid and often disorienting dreams.
Sometimes, too, vivid dreams and hypersensitivity run along together. (I can't say that one triggers the other.) That seems to be the case these days.
In such times, it's important to find ways to stay grounded - to know what's true even if emotions try to tell us otherwise, to stay active physically, and to identify tasks that are fairly simple and easy to complete. For me, stacking firewood is just such a remedy. At the end of an hour, there's order where there had been just a pile of thrown 18" logs.
Entropy says that things tend to move from order to disorder and that it takes work, energy to create and maintain order. Energy may sometimes be in short supply, so, in such times, it's good to be able to apply to places where the results of the effort are visible.

Alzheimer's is no laughing matter, so ...

we won't laugh when we read this article.
I think I told you about the time that I went to a group therapy meeting barefoot. In the warmer weather, I usually leave my shoes in the car and go around the house barefoot. Well, one time, I left my shoes at home, drove to the therapy meeting, and then had the choice of going in barefoot or going home, getting my shoes, and coming back halfway through the meeting. I decided that I needed the meeting more than my shoes.

A more appropriate word choice might be in order

Telegram.com - Principal is not rehired: "Now the legally blind principal, who last year filed a complaint with the Massachusetts Commission Against Discrimination saying he had been harassed by the administration, is looking at his legal options."

Grass fed beef liver: Vitamins, Minerals, Omega 3s :: Rebuild from Depression Blog

I enjoy reading the Rebuild from Depression Blog, but I can assure you that I've never said these words: "Beef liver is my 'food of recovery,'"
From Grass fed beef liver: Vitamins, Minerals, Omega 3s

Black box warnings and reduced depression diagnoses

Over the past few years, the FDA has required stronger warnings regarding an increased risk of suicide as a result of taking some anti-depressants. The reasons for the increased risk aren't clear. It could be that the meds trigger increased suicidiality (thoughts of suicide) or that the improved energy levels in some patients gives them the strength to act on those thoughts. The risk seems greatest when antidepressants are given to teenagers (or younger).
An unintended side-effect of the strong warnings is that doctors, primary-care physicians, at least, are reporting fewer cases of depression and prescribing meds less frequently. See Impact of U.S. antidepressant warnings still felt. (Overall anti-depressant use hasn't fallen, just those prescribed by PCPs.)
Again, the reasons for this shift aren't understood very well, but appear to be related to concerns among doctors and patients (and/or patients' parents) that the increased risk isn't worth the potential benefit.
There are a lot of legitimate concerns regarding medications and, particularly, the over-prescribing of meds in the past decade. That said, this report also shows that physicians are not prescribing alternatives, such as older types of anti-depressants or counseling therapies. As a result, fewer people are being diagnosed with and treated for depression.
How bad is this? Not sure. Suicide rates during this period haven't changed significantly.

Problems of life vs. problems of illness

Some years back, a psychiatrist pointed out that there are differences betwen problems associated with illness (depression) and problems of life. It was a very helpful comment, helping me to assess whether my difficult days were the result of something intrinsic or a set of external events.
For example, I can ask myself, "Would a person without depression feel as I do about this situation?"  Being sad when my parents died or when we learn of our granddaughter's diabetes, those are situations where most people would be sad, even for quite a while. If the troubled feelings go on for a while (more than a couple of weeks, for example), it's probably a good idea to talk with someone such as a therapist or other trusted counselor.
But, if I'm not sad or angry or confused during such difficult days, then it may be time for a check-up from the neck up. My feelings might be dulled by meds or by depression. In any case, not feeling is, for me, even more dangerous than having excessive emotion over trivial things. (There have been times when the need to make the decision between doing the laundry or going grocery shopping turned me into a puddle in the middle of the kitchen.)
Lately, we've had an extraordinary amount of tension, fear, and grief in our lives. I won't go into detail here because it involves other people and some of their private concerns. Nonetheless, it's been devastating. "Worse than death" is a phrase that keeps coming in conversations.
And yet, looking at it from a parochial "I've been crawling through a major depressive episode for three years now." view, my responses of sadness, anger, and exhaustion are pretty much on target. It feels lousy because it is lousy and to feel otherwise would be a very bad thing, indeed.

The Growing Push for "Mad Pride"

Presented without much comment - The Growing Push for "Mad Pride" | Newsweek Health | Newsweek.com
"After all, aren't we all more odd than we are normal?"

Senator Grassley queries NAMI regarding funding and policy

Senator Charles Grassley (R-Iowa) has sent a letter to National Alliance for Mental Illness (NAMI), requesting information about the non-profit mental-health-advocacy to disclose if and how its sources of funding may have influenced its policy decisions.

“I have come to understand that money from the pharmaceutical industry shapes the practices of nonprofit organizations which purport to be independent in their viewpoints and actions,” Grassley wrote in his letter. 

This is unsettling news. NAMI has done a lot of good for a lot of people, particularly for people who, because of the nature of their illnesses, often are not able to advocate for themselves. That the potential for a conflict of interest (or worse) exists leaves a particularly vulnerable population adrift.
Stay tuned.

via Beyond Meds

Work and depression

In an effort to manage health care costs and (we hope) to promote well-being among employees, employers are increasing their efforts to help employees manage chronic health conditions.
This, as we might suspect, is a complicated development. The financial and productivity costs assocated with chronic conditions, such as depression, can be substantial. (Here's way to quantify the costs - Workplace Depression Treatment Savings Calculator.) Bringing those costs under control is generally regarded as a good thing.
Planned carefully, work can be good for a person with depression, helping to build confidence, self-worth, and purpose.
Another article shows that employers reap benefits from knowing about their employees’ depression. Again, they're better able to manage the costs, attendance, and productivity concerns if they know what they're dealing with.
For the employee, however, such visibility and candor doesn't always lead to a good place. An Australian study showed that one in five Australians would not work closely with someone suffering depression, and older men and migrants tend to view the illness negatively. Also, such program are often costly and ineffective.
A few additional notes:

• The level of support that I've received from my employers, as I've dealt with depression at work, have ranged from excellent to decidely unhelpful. In my experience, most employers will try to do the right thing and will succeed. Some will make well-intentioned mistakes.
  
• The Americans with Disabilities Act (ADA) provides you with significant protections, including privacy rights. 
• Because of the ADA, as much as an employer might genuinely want to help, there are limits to the amount of detail that an employer can receive regarding an employee's medical condition.
• Most wellness programs are administered by insurance companies, on behalf of the employer. Even though insurance companies can and do have a great deal of detail regarding your treatments, they cannot share your information with your employer.

Disclaimer: I am not a lawyer. Your mileage may vary. May contain peanuts. Coffee is hot. Contents may settle during shipment .Driver does not carry cash.

Finding our way back and then forward

In a Nichols and May skit, Elaine May plays a mother who wishes that her son would call and visit more often. She reports that she's going into the hospital so that the doctors can x-ray her nerves.
I've noted that, of late, things are going pretty well. My days are full with interesting and often useful activities, my mood is good, and I can often make and meet commitments - all signs that point toward health. I feel like I'm on my out of the woods, but I also know that I've felt like this before.
Even a momentary distraction can have one turned around and headed back into the underbrush. Yesterday evening, for example, a chance reminder of a difficult relationship at a former job was enough disorient me. It didn't last long and that's also part of the good news, that a bad moment doesn't always have to lead to a bad night, day, month. You get the idea.
There's a very good blog post over at Recovery, Well-Being and Purpose | Storied Mind, addressing this change of perspective, getting beyond survival mode and (back) into living with a purpose for a future.
One of the continuing challenges, though, is staying grounded, being able to observe and accept what's really going on with us, not just what we wish would or wouldn't be happening. 
Wouldn't it be great to have some definitive, external, verified, repeatable test that could a) diagnose depression, b) determine the severity, and c) chart our progress over time so that we could know if a treatment is making a positive difference.
Instead, we have to rely on the BDI and other self-reported measurements. It's a lot like those eye tests ("Which is better, 1 or 2?") where your ability to see clearly for the next months or years is dependent on making a fine distinction that you just don't know how to make.
There is some encouraging research, such as in these articles, Dr. Francis Lee Recognized For Developing Genetic Test To Guide The Treatment Of Depression and Possibility Of Brain Scan-assisted Diagnosis For PTSD A Step Closer. Other research (Early Brain Marker For Familial Form Of Depression Identified By Columbia Researchers) may lead to early identification of people who are greater risk for development of depression. (We'll leave aside the ethical, political, and insurance risks of such predictions for another discussion.)
Getting where you're going depends on knowing where you are. Or something like that.

Seroquel update

Two weeks ago, I spoke with my psychiatrist and we agreed that it would be a good idea if I could do without Seroquel.It's been about a week now since I stopped.
Not surprisingly, the biggest impact has been on my sleep. Typically, I go to bed around 10, sleep for an hour-and-a-half, perhaps two, and then am awake for most of the night. I'll catch a few hours more, perhaps in the early morning or in a short nap during the day. In all, though, I've averaged less than five hours per day since I started reducing and then stopped the medication.
That said, I feel better than I probably ought to feel. The tiredness that I feel is quite different from the daytime grogginess brought on by Seroquel. I have been able to think reasonably clearly and get the most important stuff done each day. My mood is good.
I'm under no illusion that there is no risk here. I've changed medication regimens before, seeing significant improvements for weeks and even months, only to spin back into trouble. I'll be careful and, most importantly, honest with myself and my family about how I'm doing.
Nevertheless, with all that's coming out regarding Seroquel's side effects and how AstraZeneca has not been totally forthcoming regarding the company's test results, I feel much safer without the drug.
By the way, I keep a collection of links regarding Seroquel on delicious.com. You can find the links here. I update the list almost daily. The Furious Seasons blog has done some very good reporting on Seroquel and AZ.

On Seroquel (and off)

The reports about Seroquel and AstraZeneca's behavior during the approval process get scarier. The AZ lawyer commenting on the various lawsuits reminds me of Nathan Frum, the character played by Martin Short, who was the lawyer defending the tobacco industry.
So, after doing my homework, including reading the Seroquel Prescribing Information (PDF file) that's been updated recently, I had an appointment with my psychiatrist and discussed the option of discontinuing Seroquel. He thought that it was a fine idea.
So, I've been reducing my dosage and, last night, went without it. I had a lousy night's sleep, which isn't surprising, but have felt good. My doctor and I agreed that, if the need presents itself, I can start taking it again, but I only need to do so for the duration of a difficult time.

---

Here's a just a few of the links about Seroquel that I've collected in the past few weeks:
You can see an updated list of links in my Delicious bookmarks.

AstraZeneca Documents Released in Seroquel Suit - NYTimes.com

AstraZeneca Drug's Effectiveness Questioned - WSJ.com

AstraZeneca Responds

AstraZeneca Warned Japanese Doctors of Diabetes Link

AstraZeneca's Seroquel Documents Are a Bonanza for PlaintiffsFDA Panel To Review AstraZeneca's Seroquel April 8 - EasyBourse actualité 

Furious Seasons

Furious Seasons - Adverse Event Report Filed About Seroquel 

Furious Seasons - Seroquel Documents Now Available

Furious Seasons - Seroquel Documents: "Buried" Studies And A Psychiatrist Who Claimed Patients Lost Weight On The Drug

Health Blog : One Other Thing About AstraZeneca's Seroquel

Seroquel Documents: AZ Knew Of Weight Gain Problems In 1997

The Carlat Psychiatry Blog: The Seroquel Deception Documents

justAna: AstraZeneca and FDA - The mockery of science and health

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What's the oposite of the placebo effect?

I've spent a half hour mucking around in English-Latin-English dictionaries trying to locate the appropriate word that describes the opposite of placebo. We know that the placebo effect is, in brief, is a benign or, in some cases, non-operative treatment that results in a patient's improvement. Most of the time, we tend to dismiss placebos as a cheap trick played on gullible patients. (There is, just to complicate matters, some science that indicates that the placebo effect may indeed be real, even though we can't explain why. See Michael Brooks' 13 Things That Don't Make Sense.)
Generally, the word placebo is translated as I will please, from Placebo Domino in regione vivorum, for example. My Latin knowledge is from long ago and far away, so I can't find the negation of placebo, I will not please, meaning something that ought to do good, but which the patient believes that it does not do good.
Seroquel is falling into that latter category for me. I've been taking Seroquel in varying doses for quite a while now, close to three years. I've also had some physical symptoms, such as weight gain, pain, and some other stuff, that several specialists have been examining. I had a muscle biopsy last year to try to understand why I had an elevated CK level and unexplained muscle pain.
Today, AstraZeneca announced a reformulation of Seroquel, Seroquel XR, for the treatment of bipolar depression. (Meds such as Seroquel are often prescribed as augmentation to primary depression treatment as well; such has been my case.)
So, I'm reading through the disclaimers, side effects, and other warnings in this new product and discover that, well, read for yourself:

The most common side effects are drowsiness, dry mouth, increases in cholesterol and triglycerides, constipation, upset stomach, dizziness, a sudden drop in blood pressure upon standing, weight gain, increased hunger, tiredness, increases in blood sugar, difficulty speaking, and stuffy nose.

Six out of 12.
In addition, from their full prescribing information (PDF):

Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including SEROQUEL. Rare cases of NMS have been reported with SEROQUEL. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia).
Additional signs include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure.

Bingo. Elevated creatine phosphokinase, also known as creatine kinase (CK), levels.
I've been using the World Wide Web for a long, long time, and know that there are lots of loony reports of people who take a medication and then discover that aliens are sneaking into their refrigerators and eating their lunches.That's why I've been really careful about trying to rely on authoritative sources, such as the National Institutes of Health and AstraZeneca itself, to find out what might be going on.
Five years ago, there were suspicions that this class of medication might be implicated in some otherwise unexplained findings regarding CK levels, muscle pain, and the like. It's only been recently that the drug manufacturers have been publishing more detailed warnings of the small percentage of patients who might experience some potentially very dangerous side effects. We can only speculate that some of the lawsuits regarding Seroquel, Zyprexa, and their cousins might have something to with the new wave of candor.
As always, don't stop taking meds without consulting with your doctor. Your mileage may vary.

Steps forward don't come easily.

The year has started off with enthusiasm and good energy. We had three of our granddaughters stay overnight on New Year's Eve, went to see Blue Man Group with Krista, and celebrated her and Mike's birthdays. The weather has been harsh at times, with ice and snow and sharp cold, but it's been a series of good challenges. Clearing away the snow and ice, and even the fallen branches from last month's major ice storm, has required hard physical work, leaving us tired and satisfied.
I was expecting that the good energy was going to continue as I returned to college to take a course on legal research. The plan was that the course would help me get ready to assist an attorney friend with research for patent, trademark, and copyright applications. That was the plan and, like many plans, it was overcome by events. The events in this instance came from the reality that, although I'm a lot better than I had been, I'm still susceptible to being blind-sided by symptoms of depression - sadness, weepiness, indecision and confusion, and low energy. I went to class and did well, enjoying the subject material and participating in discussions. I'd then leave class and feel the energy just drain away, as though someone had slit the side of a bag of rice. After a couple of classes and a continuation of the symptoms, I concluded that now's not yet the time to take this course and, by extension, not yet the time to be planning to return to work.
Already I feel a bit better. I'll be in touch with my doctors all the same, to see if I need a change in medications or other treatment. Marley and I had a nice walk to Worcester this afternoon, enjoying the sunshine. We have a storm forecast for tomorrow, followed by several cloudy days. It's back to the basics. I have many, many blessings in my life, so setting aside this one adventure leaves room for some of the other goodies to come in.

The fourth of the new year

The good news is that there's little to report. It appears that we've found a reliable mix of meds - Emsam and Seroquel, along with a decent sleep aid - Temazepam, and a few basic CBT principles to keep my moods steady and positive.
Sleep can still be an adventure. This morning, for example, I woke at 3. A few other nights, I've slept right through. Next Sunday evening, I'm scheduled for a sleep study that may help us identify if there's anything else going on. (Sleep apnea is a common culprit.)
I'm very grateful that we've found treatments that have improved my quality of life. For lots of folks,  not only can they not find treatments that work, but the science around treatments is still pretty messy.
In the meantime, I've started to take on projects and responsibilities that have many of the attributes of what life had been:

• I'm participating in two non-profit organizations - Joseph's Project, an organization that delivers food to families in need, and the Queen Lake Association, an organization that supports recreation and environmental quality of Queen Lake.
• In addition to my personal blogs, I'm a regular contributor at the Real Worcester web site.
• In a few weeks, I'll be starting back to school, taking one course on Legal Research and Writing at our alma mater, Mount Wachusett Community College.
• I've even been kicking the tires on a couple of open-source projects that need technical documentation help.
• I've been participating in family gatherings around the holidays, including Christmas parties and a trip to First Night with our three youngest granddaughters.  Today, we take our oldest granddaughter to Boston to see Blue Man Group, a tradition that takes place when a child turns 13.
  

It wasn't all that long ago that the activities of daily living (ADLs) were all that I could handle. And even now, a tough day or two will catch me by surprise. Usually, the tough days are triggered when I get too far out in front of myself, getting too ambitious or excited and then losing my footing. It's a solemn reminder that I'm better, but not all better.

Onward, then.