My doctor and I are changing the medications I take to make my brain behave better. This is probably a good thing, and I’m game. Especially since I’m not working right now I can afford to take some chances in order to improve things. Plus: SCIENCE!
The first thing we’re doing is switching out Wellbutrin for a drug called Lamictal. As the “ictal” in the name suggests, this stuff is used to reduce seizures. It’s also given to people with bipolar disease, which I don’t have. However, the problems I do have include some things that bipolar people get too like racing thoughts and mood swings. And this drug is also good for plain old depression, which is one of my symptoms. The other benefit of Lamictal is that part of the plan calls for dumping the Lexapro too, and that is apparently much easier with this stuff added. I applaud that because I tried to quit Lexapro before and the discontinuation symptoms were just as bad as the recurring depression. Ecch.
Lamictal is also a tricky drug. You have to start it very slowly. This is mostly because one of the (rare) side effects is a rash. If you get the rash you stop taking the stuff right away, because it can be lethal. Therefore the FDA requires that you start with a very small dose so that you’ll know to stop it before you take enough to make yourself sick. Good call. Another problem is that Lamictal acts weird with other drugs, much more so than most of its colleagues. A quote from the always useful and amusing crazymeds.org site: “Will interact with medications you aren’t even taking.” Apparently it can also give you headaches. I’d notice that for sure because I never get headaches.
If I don’t get a rash and/or die and if it seems to be treating me well at full dose, then we’re going to phase out the Lexapro. The likely next step is that I will take one of a class of drugs called MAO Inhibitors (MAOI). These have been recommended to me before because of my particular symptomatology. They are very powerful and useful in a lot of cases. Unfortunately, they also come with dietary restrictions. They mess with a digestive enzyme and certain foods become toxic. A lot of good foods: real cheese, red wine, real beer. It’s a huge pain in the ass and a big quality of life hit. I’d also worry that I would just forget and eat the wrong thing and die.
The good news is that one of them is now available here in a patch. The patch makes the dietary problems way less, especially at low dosages, because it’s not mixing up with food in the gut. So I might be able to get the benefit of the MAOI without dying or giving up lots of foods.
The whole business is tricky and complicated. I trust the guy who’s working on it to know about as much as anyone in the field does, but everything is a science project in psychiatry especially when there are multiple drugs going on. No matter what it seems that I’m likely to be on four separate neurologic or psychiatric medications for quite a while, and I wonder if anyone even knows what’s going on.
Here we go…
After today’s phrenology session I had an interesting talk with Brain Lady. I found myself explaining to her why she sounded like a postscientific wacko at first, before I learned more about her. Most of the problem is her language. She speaks Science and has been working at very technical jobs in the mental health field for 20 years, but when she’s explaining things to a client she uses analogies and metaphors that have been totally ruined by New Age bubbleheads.
For example, she will say “I’m doing this site to push the energy back over to the other side of your brain”. On further questioning, she explains that this is a thumbnail description for a poorly understood phenomenon in which treating one site causes the voltages to go down there and up in another part of the brain. She doesn’t literally believe that she is pushing the energy around. She refers to treating multiple injuries as “like peeling off layers of an onion”. This sounds like she believes in concentric spheres of some intangible substance, but again it’s a simile. Her observations show her that multiple injuries often require multiple stages of treatment, but there isn’t any proven one-to-one correspondence between the injuries and the stages of treatment. And when she’s talking about electrical activity and mental acuity increasing after treatment, she calls it “waking up the brain”; another analogy. All of these things sound like something the local Crystal Anus Delver at the Metaphysical Bookhonk would say. In Brain Lady’s case, she’s working off many years of academic study and clinical experience in developmental disability, head injuries, special education, substance abuse treatment, and psychotherapy.
The other bad news I had for her is that her stuff sounds like Scientology. Wires on your head, healing old injuries, increased states of awareness, oh dear. You’re expecting Tom Cruise to appear stage left and congratulate you for choosing the right path. Here’s the hilarious part: she knows nothing about Scientology. As I was explaining how many parallels there are, her eyes got wider and wider. “Oh no, do people think this is like Scientology? That’s just a dumb cult!” Poor thing, she’s spent 20 years in the Science Hole and working with actual patients, and hasn’t noticed some weird cultural trends.
She pointed out that she doesn’t speak in Science much to clients because communicating the statistical links between voltage differentials and affective disorders to people with head injuries can be frustrating to both parties. I think I did manage to get across that she was using language and analogies that had been poisoned, though.
For my own part, I told her I had only really started trusting her judgment the day she went off on a rant about attribution errors and the importance of knowing your independent variables and not trusting your subjective observations, with several anecdotes of failed studies that hadn’t taken these precautions.
Especially when half of the questions make me say “Well sometimes yes and sometimes the opposite!”
I decided to do some armchair research on this thing I’m trying. First stop was wikipedia, where a neurofeedback article had been flagged as both “neutrality disputed” and “needs to be cleaned up since May 2005”. Uh oh. Sure enough, there are links to Scientology everywhere, and the tone of the article is not only dismissive but actively disparaging. Not very wikipedia. A link is provided to the talk page which is the usual ridiculous holy war involving pro- and anti-neurofeedback parties and of course Scientology.
It was depressing in that “Oh man, there goes that Internet Guy again” way. That guy in this case being njyoder, a talented and energetic troll who baits feminists and particularly rape awareness organizations.
The actual professional association seems to be pretty sane and know their limits.
New cures bring enthusiasm, messianic prose, The Solution To Everything, cranks, and naysayers. Looking around the web in a first-click way I see all of those in about ten minutes. From my point of view it’s worth a try, since it doesn’t seem likely to break my brain. At the worst I’ll lose $200 a week for a while and then get disgusted. Since I’m already disgusted, here we go.