blog: In the Shadow of Fetzima
The Drug that Poisoned Me and the Pressures of Capitalism
Date posted: 2015-02-26
👋 HEY!: This article was originally written in February 26, 2015, and is being reproduced here from the original Medium post. I was the original creator of this.
Adulthood is a strange thing. It’s a time of surprisingly gradual transitions and of gentle retrospect. Hair seems to shift places, you start to wonder about things you thought you’d never think about, and you start acting in a bizarrely responsible way — and all of this happens so slowly, you only notice it when you catch your own reflection in a mirror or hear your voice on recording every once in a while. I’ve come to learn that adulthood is, in its purest form, a series of realizations.
One of those slow realizations was that I was becoming a morning person. Once the kind of nerd that would stay up until 4 am without a trace of sleepiness in sight, I was gobsmacked to learn that I was beginning to become unable to sleep past 10 am on weekends, no matter how tired I had been the night before, or how much I had done to deserve it. The fact of the matter was, this was my lot now: I had become one of those ‘morning people’ I would beam cross expressions at while waiting impatiently at the office coffee pot.
After a year-long spree of waking up early and immediately springing out of bed (much to the chagrin of my sleeping girlfriend), I had another adult realization: for some reason, I started to feel bereft in the mornings, and it showed no pace of slowing down. I would wake up at 10 am and feel nothing. No energy, no excitement to go make some coffee, no giddiness to grab that first bowl of cereal in the morning.
I felt nothing.
“Ugh, my anti-depressant must be not working anymore,” I thought to myself.
If you have never taken anti-depressants, they are really fascinating medicines because they shine a light in on the sheer tenacity of the human brain. Brains ferociously self-regulate themselves. It’s the scientific basis of tolerance. If you take a foreign chemical that affects your brain, your brain responds by getting wise to said foreign chemical’s schemes and growing around it. When you suddenly need more coffee to feel awake, this is because your brain sees caffeine as an interloper and attempts to change shape to stop it from working. The phenomenon of tolerance affects almost any psychotropic drug — this extends similary to anti-depressants.
The effectiveness of all anti-depressants is judged on something called an efficacy grade — most anti-depressants will have one long after they leave FDA approval, although the FDA attempts to make a valiant guess based on a few years’ worth of data. Eventually, all anti-depressants reach a point where the brain routes around its therapeutic effects, and they stop working. This, however, isn’t typically an overnight realization; it can take months, if not years, for a patient to notice what’s going on and put a finger on it. Some are (oddly) fortunate because they notice a sudden and violent re-emergence of suicidal feelings or anxiety — others can wait a long time until they realize something is wrong.
For once in my long journey with anti-depressants, I was solidly in the latter camp.
After successfully being on Viibryd (Vilazodone) for about two years (after supplimenting it with Abilify), I knew had one of those adult realizations that it was time to switch while I still had the chance. I wasn't ready to get pulled into the endless void of suicidal ideation — I needed to make a change immediately.
I visited my doctor, and after some flimflammery with my insurance company deciding that I didn’t need to be on Abilify anymore, he immediately recommended I try this really neat new drug called ‘Fetzima’ (Levomilnacipran). He dropped about 4 boxes of samples on me without thought — “This drug, I’m told, is supposed to help people with motivation problems.”
“Shit,” I thought quietly. “I have had motivation problems my whole life. Could this be the push I need to salvage what was left of my hobbies?”
After all, this is the doctor that showed me the way to Viibryd (Vilazodone), which was the first anti-depressant I’d taken that took away a lot of the things I hated about Zoloft (Sertraline): It let me have sex, I stopped sweating day-glo yellow, I stopped gaining weight, and most importantly, it worked! How could he steer me wrong again?
Well…
About half a week later, desperate to feel some kind of change in my mental state, I started taking the introductory dose of Fetzima. The plan was 20 mg for two days, then 40 mg after that while simultaneously tapering down from a daily 40 mg Viibryd dosage. I started to do some research on it, and much to my surprise, I kept coming up blank. Impossible, I thought — if the sun shines on it, I can find it. But all I kept turning up was an endless stream of posts on depression message boards asking the same question: “Does anybody have experience with Fetzima? I just started taking it.” Some quit after a few weeks due to withdrawal symptoms, others persisted and assumedly vanished into normalcy.
I thought I would be one of those until, a few weeks ago, I started feeling strangely at work. My heart was racing, my hands were trembling, the room was absurdly bright, I was unable to speak without slurring and most alarmingly, I was having trouble keeping my hands grasped. If I looked away, it was like my hands were no longer part of my body. I dropped my sandwich probably 10 times — and at that point, I knew something was seriously wrong.
Was I having a stroke? Am I even old enough for something like that to happen? My girlfriend pleaded with me to call my doctor’s office. I kept refusing; I was too shy to bother my super awesome doctor when he was at work. Eventually, she called for me — the nurse told her, in her words, to ‘not even fuck around: get to an emergency room now.’
She showed up at my building and whisked me away, whether my boss liked it or not. It was a 6 block walk from my office to Hahnemann Hospital, through LOVE Park and past City Hall, one of the busiest places in the city during the day. Every walker about their day was a terrifying threat out to hurt me in some way. I felt myself recoiling into my girlfriend’s arm with every passerby — why was I so fearful? This wasn’t me at all.
The hospital, much to their credit, got me into a bed in the emergency room in 10 minutes flat. Stroke victims are preventable if they get to them quickly enough, so if you show any symptoms of a stroke, you’re at the head of the line faster than the president with diarrhea. I waited for 5 hours as my blood pressure and heart rate spiked wildly.
An hour or so in, a doctor came in and made his confusion apparent. He had never heard of Fetzima, nor did he understand what could be wrong with me. I didn’t have all of the classical stroke symptoms, but something was very clearly wrong with me. Unable to speak faster than a word every few seconds, my girlfriend spoke for me — “he’s tapering from one anti-depressant to the other,” she said pleadingly to the doctor. His face twisted immediately from one of intrigue to one of a man who just had an idea. He excused himself, passed through the ratty seperator curtain and disappeared into the hallway.
20 minutes later, he returned with a diagnosis — a form of anti-cholinergic toxicity called ‘serotonin syndrome’. Basically, he went on to explain, having both Viibryd and Fetzima in my system at once had caused my brain to become soaked in too much serotonin, a key chemical used to regulate brain function, and the cause of my chronic depression. Apparently, having too much serotonin in your brain can cause your brain to stop regulating basic body functions, like heat management and, y’know, breathing. If I had taken the drug for any longer, I was told that I may have sustained grave injury, or at worst, death.
The pieces came into place, finally. Of course I had heard of serotonin syndrome — that’s the disorder that folks who use MDMA or certain opiates get when they take too much or take it too often. I poisoned myself by taking both medicines at once.
I was instructed to stop taking my medicine cold-turkey and to follow up with my doctor in the morning.
What followed was one of my worst weeks in recent memory. Between unending brain zaps, being unable to walk or stand up, and having terrible, swallowing suidical thoughts, I was capable of doing little more than sitting in my bed, staring at the ceiling. Anti-depressant discontuation syndrome isn’t the worst of the withdrawals, and certainly not deadly like Benzodiazepine withdrawal, but it is isn’t last on the list either. A living hell. I asked around about how long the brain zaps last — some said 2 weeks, others said they are still feeling them 8 years later. Fear was paralyzing at that point.
The Internet offered no real help on how to alleviate the symptoms. Some offered up promises of Omega-3 pills helping things, others suggested kooky homeopathic medicine. I tried it all, and nothing seemed to reduce the aggressiveness and life-interruptingness of these brain zaps. Thankfully, they started to eventually dissipate on their own after about two weeks.
The week after, I returned to work reluctantly. Focusing was incredibly difficult, and the stress of my job only made the symptoms worse. I wouldn’t recommend it. After the stresses of that week, I settled down with my girlfriend to check out the latest episode of Last Week Tonight with John Oliver, a show the both of us have quickly become fans of. The focus of the episode we watched was about pharmaceutical reps, and the weird relationship they have with doctors.
There was a lot of ground covered — most notably that pharmaceutical companies spend billions of dollars marketing their drug directly to the doctors who prescribe them. They buy them lunches, take them on trips, give them tchotchkes with their drug’s name on it in exchange for the doctor prescribing their drug to patients. It is, in effect, a kickback program. Drug reps even have access to a database that shows when a doctor prescribed the drug, and in what quantities.
Alarming, yes, but in the past year, the federal government made sweeping changes to document the kind of spending that goes on, and to which doctors, the results of which were published on OpenPaymentsData.CMS.Gov. You can plug in your doctor’s name and see (approximately) how much they accepted in pharma rep dollars, and from which companies.
I plugged my doctor’s name in and was a bit nonplussed when I saw that he had accepted nearly $950 in food, beverage and travel in just 6 months. And guess which company I saw as the most recent expense?
Forest Laboratories, the manufacturer of Fetzima.